Management Plan for a 71-Year-Old Male with Intermediate-Risk Prostate Cancer
The recommended management plan for this 71-year-old male with low-volume, intermediate-risk prostate cancer who has already received external beam radiation therapy (EBR) includes continuing tamsulosin (Flomax) for BPH symptoms and implementing PSA monitoring every 3 months as planned.
Current Patient Status Assessment
This patient presents with:
- 71 years of age
- History of BPH with mild stable urinary symptoms
- Prostate cancer with mixed Gleason scores (Gleason 6 in left side, Gleason 7 in right side)
- Status post external beam radiation (EBR) in June 2024
- Current PSA: 2.2 ng/mL
- Normal urinalysis
- No bothersome genitourinary symptoms
- Currently on tamsulosin (Flomax)
Risk Stratification
Based on the NCCN Guidelines 1, this patient falls into the intermediate-risk category due to:
- Gleason score of 7 in one core (right side)
- Low volume disease (only 3 cores involved)
- PSA < 10 ng/mL
Post-Treatment Monitoring Plan
PSA Monitoring
Clinical Examinations
- Regular follow-up visits should include digital rectal examination (DRE) 1
- Although the patient refused DRE at this visit, it should be encouraged at future visits as it remains an important component of follow-up care
Medication Management
Long-term Surveillance Considerations
- If PSA begins to rise, more frequent monitoring may be indicated 1
- Consider multiparametric MRI if PSA rises and there is concern for recurrence 1
- Annual urinalysis and renal function tests should be performed to monitor for complications 1
- Symptom assessment at each visit to evaluate for disease progression or treatment-related side effects 5
Potential Complications to Monitor
- Radiation-related urinary symptoms may develop or worsen over time
- Sexual dysfunction (up to 45% in radiation therapy patients) 5
- Urinary incontinence (less common with radiation than surgery) 5
- Rectal symptoms or complications from radiation therapy
Patient Education Points
- Importance of adhering to follow-up schedule
- Need to report any new urinary symptoms (hematuria, increasing obstructive symptoms, pain)
- Significance of PSA monitoring in detecting early recurrence
- Benefits of continuing tamsulosin for managing urinary symptoms
This management plan aligns with current guidelines for intermediate-risk prostate cancer patients who have undergone definitive radiation therapy, with appropriate medication management for concurrent BPH symptoms. The 3-month follow-up interval for PSA monitoring is appropriate given the patient's recent treatment and risk classification.