# GUIDELINE OBJECTIVES
The primary objective of this guideline is to develop recommendations related to the frequency by which prostate-specific antigen (PSA) levels should be tested in men after curative-intent treatment for prostate cancer and to define the most appropriate diagnostic testing if biochemical (BC) recurrence occurs. The secondary objective is to develop recommendations that address psychosocial issues, sexual health, fatigue, urinary health, and bowel heath outcomes associated with treatment for prostate cancer.

# TARGET POPULATION
Prostate cancer patients who have undergone curative-intent treatment are the target population for this guideline. For prostate cancer patients who are on active surveillance, please refer to PEBC Guideline 17-9.

# INTENDED USERS
This guideline is targeted for radiation oncologists specializing in prostate cancer, family physicians, urologists, nurses, allied health professionals, and any other care provider involved in follow-up care of prostate cancer.

# RECOMMENDATIONS RECOMMENDATION 1
No evidence-based recommendation can be made with respect to follow-up schedule of PSA testing for prostate cancer survivors following curative-intent treatment with surgery.
However, if PSA levels remain undetectable, the Prostate Cancer Follow-up Expert Panel suggests the following as a reasonable schedule. This schedule for PSA testing is in line with PSA kinetics following therapy, other guidelines, and their clinical experience:
- Every three months in year 1 - Every six months in year 2 - Annually thereafter

# Qualifying Statements for Recommendation 1
- If PSA levels become detectable, a more frequent PSA surveillance schedule may be appropriate.
- Even though PSA follow-up is recommended annually until end of life, healthcare professionals should use their own discretion in determining the applicability of annual surveillance in patients who are unlikely to benefit from salvage therapy.

# RECOMMENDATION 2
No evidence-based recommendation can be made with respect to follow-up schedule of PSA testing for prostate cancer survivors following curative-intent treatment with non-surgery primary therapy, including any form of radiation therapy, cryotherapy, or high-intensity focused ultrasound. 

# Not usually appropriate
- Use of NaF and choline PET should be considered experimental Abbreviations: CT, computed tomography; FDG, fluorodeoxyglucose; MRI, magnetic resonance imaging; NaF, sodium fluoride; PET, positron emission tomography; PSA, prostate-specific antigen; RT, radiation therapy. Note: Salvage therapy refers to follow-up treatment provided after biochemical recurrence.

# Qualifying Statements for Recommendation 3
- Diagnostic imaging should only be ordered if that test will result in management decisions; consideration should be given to the appropriateness of the test, coupled with available salvage options. - Salvage therapies following radiation therapy or ablation therapies need to be performed at specialized centres, with imaging decisions dependent on the local evaluation process.

# RECOMMENDATION 4
In men who are not being evaluated through regularly scheduled clinical visits, a PSA test should be performed if the following symptoms develop. Additionally, diagnostic imaging specific to the patient's symptom(s) may be indicated.

# RECOMMENDATION 5
Men experience very specific and oftentimes long-lasting effects after their primary therapy, usually occurring more than three months after surgery or radiation, or during/after androgen deprivation therapy (ADT). Follow-up healthcare providers should be aware of the domains of quality of life potentially affected by treatment for prostate cancer and the management options available to combat them. Research surrounding management options is lacking. Included management options that are based on the clinical standard in Ontario or expert opinion of the Prostate Cancer Follow-up Expert Panel have been denoted with an asterisk ().
The symptoms listed are based on known profiles; however, individual men respond differently to treatments, resulting in individual side-effect profiles. To ensure optimal quality of life in these men, individual patient-reported outcomes should be measured.

# Side-Effect Primary Treatment

# Side-Effect Primary Treatment

# Management Options
- Referral to applicable support groups for coping training for couples, as well as social and emotional QoL well-being, may be considered Abbreviations: ADT, androgen deprivation therapy; PDE5, phosphodiesterase type 5; QoL, quality of life; rP, radical prostatectomy; RT, radiation therapy.

# RECOMMENDATION 6
No diet plan can be recommended because no diet plan or food supplement has been associated with improved cancer outcomes.

# RECOMMENDATION 7
For prostate cancer survivors who have completed curative-intent therapy, surveillance is required and may be provided by the treating oncologist, urologist, family physician, nurse practitioner, or hospital-based nurses. Models of care are described more thoroughly in PEBC Guideline 26-1.

# Qualifying Statements for Recommendation 7
- All healthcare practitioners that provide PSA surveillance should manage PSA as per the current CCO Prostate Cancer Pathway. - Although the identified literature only evaluated hospital-based nurse-led care and shared care within the hospital setting, expert opinion supports family physicians being involved in all survivorship care models. - With the greater emphasis on a person-centred approach to care, a multidisciplinary approach to survivorship, which includes a psychosocial focus to recovery, is recommended. Although the shared care model identified by the literature did not include a psychosocial intervention focus, in order to provide person-centred care, expert opinion supports multiple disciplines being involved in shared care models.