Editing Management of Localized Prostate Cancer (section)

==== Follow-up ====
* '''History and physical examination (including DRE), PSA and creatinine measurement at 6-month intervals, and an annual bone scan''' has been suggested
** '''Progression of disease among men on watchful waiting could occur as a result of local tumor growth and/or metastatic spread of disease to lymph nodes or bone'''.
*** Local extension of disease may result in lower urinary tract symptoms (irritative and obstructive) or upper tract obstruction from invasion into the trigone of the bladder
** '''While disease progression would most often be accompanied by increases in PSA, poorly differentiated cancers producing little PSA can progress without a rising PSA, especially with neuroendocrine differentiation. Thus, follow-up should not rely on serial PSA measurements alone.'''
** Campbells: "Because the goal of watchful waiting is to limit morbidity and not to administer potentially curative treatment, PSA testing, repeat biopsy, and imaging studies are unimportant."
* '''<span style="color:#ff0000">Indications for intervention (androgen deprivation therapy as palliative care) on watchful waiting (3):</span>'''
*# '''<span style="color:#ff0000">Symptomatic progression</span>'''
*# '''<span style="color:#ff0000">Evidence of upper urinary tract obstruction</span>'''
*# '''<span style="color:#ff0000">Evidence of metastatic disease</span>'''