NCCN Guidelines for Patients® | Prostate Cancer - page 52

NCCN Guidelines for Patients
: Prostate Cancer
Version 1.2014
Part 5: Initial treatment by risk group
5.4 High risk
Primary treatment
This chart lists the treatment options for men in the high-
risk group. The criteria for high risk include T3a tumors.
For high-risk cancers, research supports treatment unless
you’re likely to live less than 5 years when observation is
the best choice.
There are three treatment options for high-risk tumors.
The preferred treatment is EBRT to the prostate and pelvic
lymph nodes and long-term ADT. The second treatment
option is EBRT plus HDR brachytherapy and maybe ADT.
A third option is a radical prostatectomy with PLND.
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 for a total of 2 to 3 years.
Adjuvant treatment
If you had radiation therapy, you may have started ADT
beforehand. ADT is recommended for 2 to 3 years, so
you will need to keep taking these drugs after radiation
therapy has ended.
If you had a prostatectomy, 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
Treatment options
Surgical treatment
• Radical prostatectomy + PLND
Radiation therapy ± ADT
• EBRT+ ADT for 2–3 years, or
• EBRT+ brachytherapy, ± ADT for 2–3 years
Treatment options
Treatment results
High-risk features but no
cancer in lymph nodes
Radiation therapy, or
No high-risk features or
cancer in lymph nodes
Continue to complete
2–3 years of ADT
After surgical treatment
After radiation therapy
If on ADT
Cancer in lymph nodes
ADT ± radiation therapy, or
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