NCCN Guidelines for Patients
: Prostate Cancer
Part 5: Initial treatment by risk group
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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 10 or more years. Active
surveillance consists 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.
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
• Your risk for recurrence has increased,
• The 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 10 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 LDR
= Digital rectal exam
= External beam
= Low-dose rate
= Pelvic lymph node
ReadPart 2 for testing
information andPart 4
for treatment details.