NCCN Guidelines for Patients® | Prostate Cancer - page 44

44
NCCN Guidelines for Patients
®
: Prostate Cancer
Version 1.2014
Part 5: Initial treatment by risk group
5.1 Very low risk
Primary treatment
Treatment options
Expected
years to live
This chart lists the treatment options for men at very low
risk of recurrence. The criteria for very low risk include
a T1c tumor. This tumor can’t be felt with a DRE but is
found because of high PSA levels.
NCCN experts are concerned about over-treatment of
this early cancer. As a result, they recommend starting
observation after diagnosis if you’re expected to live less
than 10 years since the cancer may never cause any
problems. Observation consists of testing on a regular
basis so that supportive care with ADT can be given if
symptoms from the cancer are likely to start. Tests during
observation include PSA and DRE.
Active surveillance is an option if you are likely to
live more than 10 years. Active surveillance consists
Active surveillance
• PSA no more often than every 6 months,
• DRE no more often than every 12 months, and
• Prostate biopsy no more often than every 12 months
10–20
years
≥20 years Radiation therapy
• EBRT, or
• LDR brachytherapy
Surgical treatment
• Radical prostatectomy, or
• Radical prostatectomy + PLND if ≥2% risk of cancer in lymph nodes
Active surveillance
• PSA no more often than every 6 months,
• DRE no more often than every 12 months, and
• Prostate biopsy no more often than every 12 months
Observation
<10 years
1...,34,35,36,37,38,39,40,41,42,43 45,46,47,48,49,50,51,52,53,54,...92
Powered by FlippingBook