My uncle has prostate cancer. What follow-up care is needed?

Hello,

Welcome to icliniq.com.

I understand your concern.

Thank you for reaching out and sharing the detailed information (the attachments were removed to protect the patient's identity) about your uncle’s situation. I understand that learning about a prostate cancer diagnosis can be stressful and overwhelming, and it is completely natural to feel uncertain about the best treatment approach.

You have done the right thing by asking for guidance, and I will provide clear, safe, and evidence-based advice to help you make informed decisions. From your description, your uncle is a 75-year-old man diagnosed with prostate cancer.

His PSA (prostate-specific antigen) is elevated at 23.6 ng/mL nanograms (ng) per millilitre (mL), MRI (magnetic resonance imaging) shows a PI-RADS (prostate imaging reporting and data system) score of 5 lesions, and biopsy confirms a Gleason score of 7.

The oncologist suggested starting radiation therapy, and you are wondering whether surgery might be a better option, whether androgen deprivation therapy (ADT) should start immediately, and how frequently to monitor tests like PSA and ALP.

Based on these details, his case represents clinically significant prostate cancer, typically classified as intermediate to high risk due to the PSA, MRI findings, and Gleason score. Age and overall health are important factors when choosing between surgery and radiation.

At 75, many patients are still candidates for surgery if they are otherwise healthy, but radiation therapy is often preferred because it is less invasive and carries fewer immediate risks in older adults. Both approaches have comparable long-term control in appropriately selected patients.

Androgen deprivation therapy may be recommended in combination with radiation, especially for higher-risk disease, but the timing can sometimes be tailored based on PSA trends, tumor characteristics, and treatment planning.

Immediate initiation is not always required if a multidisciplinary team plans therapy in a stepwise manner, but this should be decided by the treating oncologist.

For monitoring, PSA is generally checked every three to six months after treatment, while ALP (alkaline phosphatase) can be monitored if there is concern for bone involvement.

Frequency may be adjusted based on response to therapy and any new symptoms. To provide more personalized guidance, it would be helpful to have copies of recent MRI, biopsy reports, and any prior laboratory results. This ensures recommendations are tailored specifically to his case.

Please keep me updated with any new reports or changes in his condition. Reviewing them can help adjust the plan safely. Most patients do well with careful monitoring and timely treatment, so it is important to stay proactive while maintaining a positive mindset.

I hope this helps.

Follow up for more queries.

Thank you.