Personalized Prostate Cancer Management Plan

Patient Information

• Name: [Patient Name]
• Date of Diagnosis: [Date]
• Medical Record Number: [MRN]

Disease Characteristics

• PSA at Diagnosis: _____ ng/mL
• Gleason Score: _____
• Clinical Stage: _____
• Risk Category: □ Low □ Intermediate □ High

Selected Treatment Approach

Primary Treatment

□ Active Surveillance □ Radical Prostatectomy □ External Beam Radiation Therapy □ Brachytherapy □ Hormone Therapy □ Other: _____

Treatment Schedule

• Start Date: _____
• Expected Duration: _____
• Frequency: _____

Follow-up Care Plan

PSA Monitoring Schedule

• First 2 years: Every 3-6 months
• Years 3-5: Every 6 months
• After 5 years: Annually

Imaging Schedule

• Bone Scan: □ As needed □ Every _____ months
• CT/MRI: □ As needed □ Every _____ months

Side Effect Management

Common Side Effects to Monitor

• Urinary symptoms
• Sexual function changes
• Bowel changes
• Fatigue

Support Services Available

• Urology: [Contact]
• Sexual Health: [Contact]
• Nutrition Services: [Contact]
• Mental Health Support: [Contact]

Lifestyle Recommendations

• Exercise: 150 minutes moderate activity/week
• Diet: Plant-based, low-fat diet recommended
• Smoking cessation (if applicable)
• Alcohol moderation

Emergency Contacts

• Oncology Office: [Phone]
• After Hours: [Phone]
• Emergency Department: [Phone]

Next Appointments

1. Follow-up Visit: [Date]
2. PSA Test: [Date]
3. Imaging: [Date]

Notes

This management plan will be reviewed and updated as needed based on your progress and response to treatment.