Test, test, test, and then test some more

[PCaWarrior]

Below is an overview of common tests and screenings that many prostate cancer (PCa) patients may need to schedule regularly. Keep in mind that individual recommendations vary based on the stage of the disease, treatment approach (e.g., active surveillance, radiation, surgery, or androgen deprivation therapy), overall health, and your doctor’s guidance. Always consult your healthcare team for personalized scheduling.

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Regular Tests & Screenings for Prostate Cancer Patients

Test/Screening Purpose Frequency/Timing Notes

PSA Test (Prostate-Specific Antigen) Monitors PSA levels in the blood to track disease progression or recurrence. Every 1–6 months (active treatment/surveillance) or as advised Frequency may change based on therapy, treatment response and individual risk factors.

Multiparametric MRI Provides detailed images of the prostate and surrounding tissues to assess tumor extent. As needed, often annually or with PSA changes Useful for evaluating local disease, especially if PSA levels rise unexpectedly.

Bone Scan Detects bone metastases if there’s a risk or suspicion of cancer spread. At baseline and periodically if indicated Recommended if there are symptoms or laboratory/imaging signs of metastasis.

CT Scan or PET Scan (PSMA PET) Helps evaluate the spread to lymph nodes or other organs. As needed (often during staging or recurrence evaluation) May be used when other tests suggest potential spread beyond the prostate.

Testosterone Level Test Monitors hormone levels, particularly if you’re on androgen deprivation therapy (ADT) or bipolar androgen therapy (BAT). Every 1–6 months Important for patients on ADT or BAT to ensure therapy is effective and to adjust doses as necessary.

Bone Density Scan (DEXA Scan) Assesses bone health to detect osteoporosis, especially important for patients on ADT. Annually or as recommended Most ADT therapies can lower bone density; preventive treatment may be indicated if significant loss is detected.

The exception is estrogen patches or gels. Bone density typically increases.

Comprehensive Metabolic Panel (CMP) Monitors liver and kidney function, and overall metabolic health, especially during treatment. Every 3-6 months or with treatment changes Helps manage potential side effects of medications and track overall health status.

Complete Blood Count (CBC) Evaluates overall blood health, including red and white blood cell levels. Every 3-6 months Useful for monitoring potential treatment-related side effects or general health concerns.

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Additional Considerations

• Individualization:

Your specific regimen may be adjusted based on the stage of cancer, treatment type, and overall health. For example, patients undergoing active surveillance might have more frequent PSA testing, whereas those receiving systemic therapy might require additional imaging and blood tests.

• Treatment-Related Monitoring:

If you are receiving treatments like chemotherapy, radiation, BAT, or ADT, your doctor might add other specific tests to monitor organ function, side effects, and overall treatment response.

• Follow-Up Appointments:

Regular appointments with your oncologist and urologist are crucial for interpreting test results and making any necessary adjustments to your treatment plan.

• Communication:

Always inform your healthcare team about any new symptoms or side effects, as these may warrant more immediate testing or changes in your management plan.

This summary is for informational purposes only and is not a substitute for professional medical advice. Please work closely with your healthcare provider to determine the most appropriate testing schedule for your specific situation.

For patients with advanced prostate cancer—especially in cases like T3/T4 with Gleason scores of 8–10—genetic testing has become an important tool in guiding treatment decisions. Both germline and somatic tests are recommended in many clinical settings to identify actionable mutations that might qualify you for targeted therapies such as PARP inhibitors or immunotherapies. Below is an overview of the types of genetic tests, what they assess, and some common considerations.

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Genetic Testing in Advanced Prostate Cancer

Test Type Purpose Common Genes/Markers Assessed Method Notes

Germline Testing Evaluates inherited mutations that can predispose to aggressive cancer and impact family risk. BRCA1, BRCA2, ATM, CHEK2, HOXB13, and others Blood or saliva sample Recommended for advanced or high-risk cases; results may influence both treatment choices and genetic counseling.

Somatic (Tumor) Testing Analyzes tumor DNA for acquired mutations that may drive cancer growth and can be targeted by specific therapies. DNA damage repair genes (e.g., BRCA1/2, ATM), mismatch repair genes, AR alterations, PI3K pathway genes, among others Biopsy tissue or circulating tumor DNA (liquid biopsy) Often performed on metastatic tissue; helps determine eligibility for targeted treatments like PARP inhibitors.

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Additional Considerations

• Clinical Guidelines:

Both the National Comprehensive Cancer Network (NCCN) and other professional societies recommend considering germline and somatic testing in men with metastatic or high-risk prostate cancer. The identification of deleterious mutations can guide not only treatment options (such as PARP inhibitors for DNA repair deficiencies) but also help assess familial cancer risk.

• Timing & Frequency:

o Germline Testing: Generally performed once, as inherited mutations do not change over time.

o Somatic Testing: May be repeated if there is disease progression or if a new metastatic lesion is identified, as tumor genetics can evolve with treatment.

• Integration with Treatment:

Results from these tests can open avenues for targeted therapies and clinical trials. For example, the presence of BRCA mutations may make a patient eligible for PARP inhibitors, while mismatch repair deficiencies might signal a benefit from immunotherapy.

• Consultation:

Because genetic testing can have implications for both your treatment and familial risk, discussing these tests with your oncologist and a genetic counselor is crucial.

This genetic profiling is becoming a standard part of the management of advanced prostate cancer, helping to tailor therapy to the individual’s tumor biology and potentially improving outcomes.

References

1. CELLSEARCH® | mPC Clinical Trials & Case Studies cellsearchctc.com/clinical-...

2. Current status of liquid biopsies for the detection and management of prostate cancer – PMC ncbi.nlm.nih.gov/pmc/articl...

3. Signatera – Circulating Tumor DNA Blood Test | Natera natera.com/oncology/signate...

4. Liquid Biopsy For All Advanced Solid Tumors | Guardant360® CDx guardant360cdx.com/

5. Evaluation of Commercial Circulating Tumor DNA Test in Metastatic Prostate Cancer | JCO Precision Oncology ascopubs.org/doi/full/10.12....

6. PYLARIFY® | Prostate Cancer Diagnostic Imaging Agent pylarify.com/

I'm going to add more blood tests to this. And inflammation calculations. Liver enzymes, D status, cholesterol, BP, PR, etc.

[petabyte]

If you are in the US I was told you can get free germline testing here (research study)

prostatecancerpromise.org/

[PCaWarrior in reply to petabyte]

Good test and simple. Consider making a stand-alone post. I did that test a couple of years back. It's germline (hereditary) and should never change. I had already done one but did this one to help the research community. Plus it never hurts to double check.