NCCN Guidelines for Patients
: Prostate Cancer
Part 5: Initial treatment by risk group
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= Digital rectal exam
= External beam
= Low-dose rate
ReadPart 2 for testing
information andPart 4
for treatment details.
of testing on a regular basis so that treatment can be started when needed.
Treatment is given when there is still an excellent chance for a cure. This option
may be of interest if you’re younger and want to avoid treatment side effects until
treatment is clearly (if ever) needed. If older, treating the cancer may not be an
urgent concern in light of other more serious health problems.
In general, PSA testing should occur no more often than every 6 months. DRE
should occur no more often than every 12 months. Doctors don’t agree on the
need for and frequency of repeat biopsies. Some doctors do repeat biopsies
each year and others do them based on test results. Examples of such test
results include a rise in PSA level or change in DRE.
A decision to do a repeat biopsy should balance the potential benefits and risks.
Risks include infection and other side effects. If 10 or more cores were removed,
the next biopsy may be done within 18 to 24 months of diagnosis. If you’re likely
to live less than 10 years or are older than 75 years of age, repeat prostate
biopsies are rarely needed.
There is debate over which events during active surveillance should signal
the start of treatment. The decision to start treatment should be based on
your doctor’s judgment and your personal wishes. NCCN experts suggest the
following triggering events:
• Your risk for recurrence has increased,
• Cancer from the repeat biopsy has a Gleason grade of 4 or 5, or
• There is a larger amount of cancer within biopsy samples or a greater
number of biopsy samples have cancer.
Besides active surveillance, there are two other options if you’re likely to live
more than 20 years. You may want treatment now since, in time, the cancer may
grow outside your prostate, cause symptoms, or both. If you want treatment
now, radiation therapy is an option. Very low risk cancers may be treated with