NCCN Guidelines for Patients® | Prostate Cancer - page 54

NCCN Guidelines for Patients
: Prostate Cancer
Version 1.2014
Part 5: Initial treatment by risk group
5.5 Very high risk
Primary treatment
This chart lists the treatment options for men at very high
risk of recurrence. Men at very high risk include those
with T3b and T4 tumors. There are four treatment options
for very 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. For ADT given with radiation, 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 2 to 3
If the tumor isn’t fixed to nearby organs, a third option is
a radical prostatectomy with PLND. When a tumor isn’t
fixed, it is more likely to be fully removed. In this case, an
operation may be able to cure the cancer.
If you have a very-high-risk cancer that can’t be cured,
ADT can be used. The goal of ADT is to control the
growth of the cancer. Recommendations for ADT include
an LHRH antagonist or LHRH agonist. If these drugs
don’t suppress your testosterone level, your doctor may
want you to take CAB.
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.
Treatment options
Surgical treatment
• Radical prostatectomy and PLND if the
cancer isn’t fixed to nearby organs
Radiation therapy ± ADT
• EBRT+ ADT for 2–3 years, or
• EBRT+ brachytherapy, ± ADT for 2–3 years
ADT when a cure is not possible
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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