NCCN Guidelines for Patients® | Prostate Cancer - page 49

49
NCCN Guidelines for Patients
®
: Prostate Cancer
Version 1.2014
Part 5: Initial treatment by risk group
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Definitions:
Adjuvant treatment:
Treatment given after
primary treatment to kill any
remaining cancer cells
Lymph node:
A small
disease-fighting organ
Pathologist:
A doctor
who’s an expert in testing
cells to identify disease
Prostatic capsule:
Tissue
that covers the prostate
Seminal vesicles:
A pair of
male glands
Surgical margin:
Normal
tissue around the edge of a
tumor that is removed
Acronyms:
ADT
= Androgen deprivation
therapy
DRE
= Digital rectal exam
LHRH
= Luteinizing
hormone-releasing hormone
PSA
= Prostate-specific
antigen
5.3 Intermediate risk
Primary treatment
Treatment options
Expected
years to live
This chart lists the treatment options for men in the intermediate risk group. The criteria
for intermediate risk include T2b and T2c tumors. Treatment options are based on how
many years a man is expected to live.
Observation instead of treatment is an option for men expected to live less than 10
years. In this case, the cancer is unlikely to cause 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 not recommended if you expect to live longer than 10 years since
the cancer will likely decrease your length of life and cause unpleasant symptoms.
<10 years
Radiation therapy ± ADT for 4–6 months
• EBRT ± brachytherapy, or
• Brachytherapy alone
Observation
≥10 years
Surgical treatment
• Radical prostatectomy, or
• Radical prostatectomy + PLND if ≥2% risk of cancer in lymph nodes
Radiation therapy ± ADT for 4–6 months
• EBRT ± brachytherapy, or
• Brachytherapy alone
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