NCCN Guidelines for Patients® Version Updates: Prostate Cancer

Following are the major updates that were included in the NCCN Guidelines for Patients®: Prostate Cancer, Version 1.2014:

  • Part 5.1 Very low risk, pp. 44
    • Replaced "Active surveillance" with "Observation" for those expected to live less than 10 years
    • Changed the frequency of testing during active surveillance
      • "PSA at least every 6 months" changed to "PSA no more often than every 6 months"
      • "DRE at least every 12 months" changed to "DRE no more often than every 12 months"
      • "Consider needle biopsy of the prostate as often as every 12 months" changed to "Prostate biopsy no more often than every 12 months"
  • Part 5.2 Low risk, pp. 46
    • Replaced "Active surveillance" with "Observation" for those expected to live less than 10 years
    • Changed the frequency of testing during active surveillance
      • "PSA at least every 6 months" changed to "PSA no more often than every 6 months."
      • "DRE at least every 12 months" changed to "DRE no more often than every 12 months"
      • "Consider needle biopsy of the prostate as often as every 12 months" changed to "Prostate biopsy no more often than every 12 months"
  • Part 5.2 Intermediate risk, pp. 49
    • Replaced "Active surveillance" with "Observation" for those expected to live less than 10 years
    • Changed the frequency of testing during active surveillance
      • "PSA at least every 6 months" changed to "PSA no more often than every 6 months"
      • "DRE at least every 12 months" changed to "DRE no more often than every 12 months"
      • "Consider needle biopsy of the prostate as often as every 12 months" changed to "Prostate biopsy no more often than every 12 months"
    • Added "Brachytherapy alone" as an option for radiation therapy
  • Part 5.3 High risk, pp. 52
    • For "radical prostatectomy + PLND," removed "if the cancer isn’t fixed to nearby organs"
  • Part 5.3 Metastatic disease, pp. 56
    • Added "Observation" as an option
  • Part 6.2 Monitoring, pp. 59
    • For "Very high risk, N1, or M1 not treated for cure," removed "with DRE" from "Physical exam every 3–6 months"
  • Part 6.3 Treatment after radical prostatectomy, pp. 60
    • Added "PET scan" to tests
  • Part 6.4 Treatment after radiation therapy, pp. 61
      • Added "PET scan" to tests
      • Clarified "TRUS biopsy"
      • Changed "Endorectal MRI" to "Prostate MRI"
  • Part 7.1 ADT for first-time users, pp. 64
    • Added "Observation" as option
  • Part 7.3 Castration-recurrent cancer with metastases – WITHOUT symptoms, pp. 66
    • Clarified in text that ADT is recommended especially if "PSADT is less than 10 months"
    • Changed "Steroids" to "Corticosteroids"
  • Part 7.3 Castration-resistant cancer with metastases – WITH symptoms, pp. 68
    • Changed "Steroids" to "Corticosteroids" after "if cancer grows"