NCCN Guidelines for Patients® | Prostate Cancer - page 55

55
NCCN Guidelines for Patients
®
: Prostate Cancer
Version 1.2014
Part 5: Initial treatment by risk group
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The pathologist will assess how far the cancer has spread within the tissue. 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 include:
• Cancer in surgical margins,
• Cancer outside the prostatic capsule,
• Cancer in the seminal vesicle(s), and
• 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
operation.
There are two treatment options if cancer is found in lymph nodes. The first
option is to start ADT now. Radiation therapy may be added to 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 monitoring and then have treatment when the levels
rise.
Definitions:
Lymph node:
A small
disease-fighting organ
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
CAB
= Combined androgen
blockade
EBRT
= External beam
radiation therapy
HDR
= High-dose rate
LHRH
= Luteinizing
hormone-releasing hormone
PLND
= Pelvic lymph node
dissection
PSA
= Prostate-specific
antigen
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