Radiation Oncology Follow-Up of Prostate Cancer Survivors Following Completion of Radiotherapy: A Population-Based Study

Prostate cancer survivors require coordinated long-term care after treatment. We examined patterns of follow-up care and identified characteristics associated with the frequency of radiation oncology (RO) visits during survivorship. We conducted a population-based cohort study of men diagnosed with prostate cancer between April 2010 and March 2019 in Ontario, Canada, who underwent first-line radiotherapy. Survivorship began three years following radiation. Using a recurrent event framework, we identified demographic and clinical characteristics associated with the rate of RO follow-up. Survivors seeking RO follow-up declined by 46.2% over five years of survivorship. Higher-risk characteristics, such as higher ISUP grade, higher stage, detectable prostate-specific antigen (PSA) score, and receipt of brachytherapy and/or hormones, were associated with more frequent RO visits. For instance, relative to International Society of Urological Pathology (ISUP) Grade 1, those with Grades 3 through 5 experienced follow-up rates that were 20%, 25%, and 34% higher, respectively. Despite concordance between patient risk and rate of RO follow-up, 23.6% of survivors continued to visit their RO providers into their fifth year of survivorship, more than half of whom were ISUP grades 1-2. Primary care follow-up remained stable. While frequency of RO follow-up appropriately reflected patient risk profile, many low-risk survivors still sought long-term RO-led care. This suggests an opportunity to encourage lower-risk prostate cancer survivors to seek follow-up care with their general practitioner.