NCCN Guidelines for Patients® | Prostate Cancer - page 48

NCCN Guidelines for Patients
: Prostate Cancer
Version 1.2014
Part 5: Initial treatment by risk group
brachytherapy alone. They can also be treated with EBRT
to the prostate and maybe the seminal vesicles but not to
the pelvic lymph nodes.
The third option is to have a radical prostatectomy. If you
choose a prostatectomy, you may also have a PLND if
your risk is 2% or higher for having cancer in the pelvic
lymph nodes. Your doctor will determine your risk using a
nomogram, which was described in Part 3.
Adjuvant treatment after prostatectomy
The tissue that was removed from your body during the
operation will be sent to a pathologist for testing. The
pathologist will assess how far the cancer has spread
within the tissue. After the operation, your PSA level will
also be tested.
Recommendations for adjuvant treatment are based
on the presence of high-risk features and cancer in the
lymph nodes. High-risk features suggest that not all of the
cancer was removed by the operation. High-risk features
• Cancer in surgical margins
• Cancer outside the prostatic capsule
• Cancer in the seminal vesicle(s)
• Detectable PSA levels
If test results find no high-risk features or cancer in the
lymph nodes, no more treatment is needed. You may
start observation. The options for when there are high-risk
features but no cancer in the lymph nodes are radiation
therapy or observation. Radiation therapy with EBRT
is given to the areas where the cancer cells have likely
spread. Treatment is started after you’ve healed from the
There are two treatment options if cancer is found
in lymph nodes. The first option is to start ADT now.
Radiation therapy may be given with ADT. ADT can
be given on an intermittent schedule to reduce its side
effects. However, the benefits of ADT in this case are
unclear. For adjuvant ADT, an LHRH antagonist or
LHRH agonist is recommended. If your PSA levels are
undetectable, a second option is to start observation and
then have supportive care when the levels rise.
Treatment options
Surgical results
High-risk features but no
cancer in lymph nodes
Radiation therapy, or
No high-risk features or
cancer in lymph nodes
Cancer in lymph nodes
ADT ± radiation
therapy, or
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