NCCN Guidelines for Patients® | Prostate Cancer - page 62

NCCN Guidelines for Patients
: Prostate Cancer
Version 1.2014
Part 6: Monitoring and salvage treatment
10 years; and 4) your current PSA level is below 10. If
you don’t meet these criteria or have metastases, the
treatment options are ADT or observation.
To confirm that local therapy is the right treatment for
you, more tests are needed. A fast PSA doubling time
suggests spread beyond the prostate. A TRUS biopsy
of the prostate along with a bone scan should be done.
Possible other tests include a CT or MRI scan of your
abdomen and pelvis or a prostate MRI.
Sometimes the prostate biopsy and imaging tests find
no cancer despite rising PSA levels. One option in this
situation is to continue observation until cancer growth
is confirmed. Another option is to start ADT. When to
start ADT should be influenced by PSA velocity, your
anxiety as well as your doctor’s concern about cancer
growth, and your feelings about side effects. A third
option is to enroll in a clinical trial. A fourth option is to
have more tests to try to find the source of the rising
PSA level. These tests can include another biopsy, MR
spectroscopy, or a prostate MRI.
There are four options if cancer has returned in the
prostate but has unlikely spread to distant sites. The
first option is to continue observation until further cancer
growth is found. Another option is radical prostatectomy
even though the side effects of salvage prostatectomy
are worse than primary prostatectomy. Other options for
local treatment include cryotherapy and brachytherapy.
Which treatment you will receive needs to be based on
your chances of further cancer growth, treatment being a
success, and the risks of the treatment.
Next steps
. If you choose ADT, read Part 7 for
recommendations. For all other treatment options, your
doctor will monitor for cancer growth. Read Part 7 if the
cancer keeps growing.
The belly area between the chest and
Removal of tissue samples for testing
Clinical trial:
A type of research that studies tests
and treatments
The spread of cancer cells from the first
tumor to another site
MR spectroscopy:
A test that measures chemicals
in cells without removing tissue from the body
The body area between the hipbones
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