What is the recommended management plan for a 75-year-old male with a history of prostate adenocarcinoma, currently presenting with urinary urgency and nocturia, and a recent PSA level of 0.220 ng/ml, after completing radiation therapy and androgen deprivation therapy (ADT)?

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Last updated: November 18, 2025 • View editorial policy

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History of Present Illness

This is a 75-year-old male with unfavorable intermediate-risk prostate adenocarcinoma (Grade Group 2, Gleason 3+4=7 with cribriform pattern in left base, Grade Group 1 in bilateral apex and right mid, perineural invasion present, involving up to 70% of cores) who completed definitive treatment with 6 months of androgen deprivation therapy (ADT) and radiation therapy (50 Gy to prostate + seminal vesicles followed by 30 Gy boost via IMRT, completed September 2022).

Initial Presentation and Diagnosis

  • March 2022: 12-core prostate biopsy revealed:

    • Left base: Grade Group 2 (Gleason 3+4=7, pattern 4 20-30%, cribriform pattern present) in 3 fragmented cores involving 60% with perineural invasion
    • Left mid: Grade Group 2 (Gleason 3+4=7, pattern 4 10%) in 3 fragmented cores involving 60%
    • Left apex: Grade Group 1 (Gleason 3+3=6) in 2 of 2 cores involving 60-70% with perineural invasion
    • Right mid: Grade Group 1 (Gleason 3+3=6) in 1 of 2 cores involving 5-10%
    • Right apex: Grade Group 1 (Gleason 3+3=6) in 1 of 2 cores involving 10% with perineural invasion
    • Right base: Benign prostate tissue

  • April 2022: Staging CT abdomen/pelvis and bone scan showed no evidence of metastatic disease, no lymphadenopathy, and no osseous lesions (incidental finding of 5.8 cm complex renal cyst with nodular enhancement requiring surveillance)

Treatment Course

  • July-September 2022: Completed definitive radiation therapy
    • 50 Gy in 25 fractions to prostate + seminal vesicles (July 18 - August 22,2022)
    • 30 Gy in 15 fractions boost to prostate (August 23 - September 13,2022)
    • Total dose: 80 Gy via VMAT technique
  • Received 6 months of ADT (timing relative to radiation not specified but consistent with standard neoadjuvant/concurrent approach)

Post-Treatment Surveillance

  • PSA trajectory demonstrates excellent biochemical response:
    • November 2022: 0.050 ng/mL (2 months post-RT completion)
    • March 2023: 0.060 ng/mL
    • October 2023: 0.110 ng/mL
    • May 2024: 0.170 ng/mL
    • November 2024: 0.140 ng/mL
    • May 2025: 0.220 ng/mL (current, 32 months post-RT)

Current Status

  • Patient appears well with no constitutional symptoms
  • Urinary symptoms: Mild urgency and nocturia x1 (likely late radiation effect or age-related)
  • Denies dysuria, hematuria, bright red blood per rectum, or diarrhea
  • Continues urology follow-up for prostate cancer surveillance and annual CT for complex renal cyst monitoring
  • Recent rotator cuff surgery with improved range of motion

Relevant Medical History

  • Atrial fibrillation with pacemaker
  • Complex renal cyst requiring surveillance

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This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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