NCCN Guidelines for Patients® | Prostate Cancer - page 50

NCCN Guidelines for Patients
: Prostate Cancer
Version 1.2014
Part 5: Initial treatment by risk group
For all men with intermediate risk, a treatment option
is radiation therapy. Research has shown that EBRT
alone often controls intermediate-risk prostate cancer.
LDR or HDR brachytherapy can be used with EBRT for
intermediate-risk cancers but will likely cause more side
effects. Brachytherapy alone can also be given.
Your doctor may want to add a short course of ADT to
radiation therapy. Research has shown that adding ADT
can extend life. For ADT, an LHRH antagonist or LHRH
agonist may be used. However, doctors often use CAB. If
you will receive ADT, it will be given before, during, and after
radiation therapy.
If you are expected to live 10 or more years, a radical
prostatectomy is a third option. 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.
There is debate over which events 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 starting treatment if your
risk for recurrence increases.
Adjuvant treatment after prostatectomy
If you had radiation therapy, you may have started ADT
beforehand. ADT is recommended for 4 to 6 months, so
you will need to keep taking these drugs after radiation
therapy has ended.
If you had an operation, the tissue that was removed
from your body will be sent to a pathologist for testing.
The pathologist will assess how far the cancer has
spread within the tissue. Your PSA level will also be
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 include:
• Cancer in surgical margins,
• Cancer outside the prostatic capsule,
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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