Got written plan from KUMC, seems to mention bad things in pathology, but not the few good like margin was a single <3mm. Sure am mad at my PCP who ignored my PSA increase on 2/10/23, I think that is when it was started and more manageable, but PCP ignored my request for referral to urologist. Then I guess stupid me for not ignoring PCP and just going, but I trusted his decision. I asked, said this jump wasn't good, but he ignored me as being overly concerned over nothing. Said less that 4 you are good. Other reading this learn from it, that was too big of a jump.
Assessment and Plan:
Jerry is a 79 y.o. male with history of diagnosis of unfavorable intermediate risk prostate cancer. He had PSA rising up to 5.23 on 12/16/2025. He underwent radical prostatectomy and bilateral pelvic lymph node dissection on 4/30/2026 ( ALL 10 NODES WERE NEGATIVE). Final pathology prostate adenocarcinoma, gleason 3+4=7, with positive left posterior margin, left seminal vesicle invasion, non-focal EPE at the left posterolateral neurovascular bundle, LVSI present, pT3bN0.

We discussed the role of adjuvant vs salvage radiation therapy in the management of patients with recurrence after prostatectomy. Indications for adjuvant radiation t herapy include adverse pathologic features such as pT3 or positive surgical margins which were present on Jerry’s pathology. There are multiple retrospective studies have demonstrated improved survival with salvage radiation therapy in patients with biochemical recurrence of prostate cancer after radical prostatectomy. We also discussed the benefits seen with the addition of pelvic nodal irradiation based on the results of the SPPORT trial (Pollack, Lancet, 2022). He has a good performance status (I NEED TO ASK WHAT GOOD PERFORMANCE STATUS MEANS) and we could consider including the pelvic lymph nodes. We explained that this may come at the cost of increased toxicity. Our plan would be to treat the prostate bed to a dose 66 Gy in 33 fractions, and we could consider treatment to the pelvis to 46 in 23 fractions. (SHE DIDN'T SAY IF THEY WOULD DO THESE ALL AT ONCE OR 33 THEN ANOTHER 46 FOR TOTAL OF 79 SESSIONS)

We reviewed the potential side effects associated with radiation therapy. These include urinary symptoms (increased urinary frequency and urgency, dysuria, and obstructive symptoms), GI symptoms (loose stools and blood in stool), and sexual dysfunction. However, urinary incontinence is relatively uncommon after radiation treatment.

We also discussed the potential role of the addition of ADT with the patient. Multiple trials (RTOG 9601, Shipley, NEJM 2017. GETUG-AFU 16, Carrie, Lancet, 2016) have demonstrated a significant improvement in freedom from progression, with RTOG 9601 demonstrating an improvement in overall survival and prostate cancer specific survival with the addition of ADT. We recommend the addition of 6 months. Given that he continues to have improvement in his urination and low PSA at 0.06, I would recommend continued monitoring of his PSA every 3 months. I would initiate ADT (DIDN'T SAY WHAT KIND OF ADT, WELL MAYBE MENTION SOMETHING THAT STARTED WITH LU) when his PSA rises to 0.1, and evaluate his urinary control. Should his urinary symptoms improve and plateau we could initiate radiation therapy.

Follow up in 3 months after his next PSA

Katelyn Kane, M.D.
Department of Radiation Oncology

I personally spent over 30 minutes for face to face counseling, discussion, care coordination, documentation, and medical record review.

PSA history:
8/19/2026 0.06
6/11/2026 0.06
1/12/2026 4.16
12/16/2025 5.23
1/28/2025 3.24
6/4/2024 3.27
2/10/2023 3.30
2/11/2022 2.29