Prostate Cancer Treatment Guidelines for Patients – Version VI, October 2007

Introduction

With this guideline, pmen with prostate cancer have access to information on the way prostate cancer is treated at the nation’s leading cancer centers. Originally developed for cancer specialists by the National Comprehensive Cancer Network (NCCN), these treatment guidelines have now been translated for the lay public by the American Cancer Society (ACS).

Since 1995, doctors have looked to the NCCN for guidance on the highest quality, most effective advice on treating cancer. For more than 90 years, the public has relied on the American Cancer Society for information about cancer. The Society’s books, brochures, and Web site provide comprehensive, current, and understandable information to hundreds of thousands of patients, their families, and friends. This collaboration between the NCCN and ACS provides an authoritative and understandable source of cancer treatment information for the public.

These patient guidelines will help you better understand your cancer treatment and your doctor’s counsel. We urge you to discuss them with your doctor. You might begin by asking the following questions:

• How do my age, general health, and other medical conditions influence my treatment choices?
  
• What are the chances that my cancer can be treated successfully?
  
• What stage is my cancer and how does it influence my treatment options?
  
• How do the Gleason score of my cancer and my blood prostate-specific antigen (PSA) level predict my outlook for survival and affect treatment options?
  
• What do you feel my strongest treatment options are?
  
• Do you recommend one treatment over the others? If so, why?
  
• What are the likely side effects of each proposed treatment, and how will they affect my quality of life?
  
• What can be done to help manage the side effects of treatment?
  
• If I want to consult with other doctors, who would you recommend?
  
• How much time do I have before I need to decide on a particular treatment?

Making Decisions About Prostate Cancer Treatment

Prostate cancer is the most common cancer (excluding skin cancer) of American men. Most prostate cancers develop in older men and grow very slowly. But some can affect younger men, especially African Americans. African-American men are more likely to develop prostate cancer, and at a younger age, than other men. In some men, the cancer can grow quickly and spread to other parts of the body, causing symptoms and, sometimes, death. This too is more likely to happen to African-American men. Treating men with prostate cancer can help them live longer and can prevent or relieve symptoms. But treatment is not the right thing for all men with prostate cancer. One reason prostate cancer is so confusing to both doctors and patients is that it is difficult to tell which men will benefit from treatment and which will have side effects of treatment that will outweigh the benefits.

Prostate cancer is a disease that needs a team of doctors — often your primary physician, a surgeon (urologist), radiation oncologist, and medical oncologist — to treat the disease. But not all men with prostate cancer should receive the same treatment, and, in some cases, the best treatment may be no treatment.

This study can help you and your doctor decide which choices best meet your medical and personal needs. You’ll find flow charts that doctors call Decision Trees. These charts show how you and your doctor can arrive at the choices you need to make about your treatment.
To reach an informed decision you need to understand some of the medical terms your doctor uses. You may feel you’re on familiar ground already, or perhaps you need to refer to the various sections listed in the Contents. Not only will you find background information on prostate cancer, but also explanations of cancer stages, work-up, and treatment. We’ve also provided a glossary of medical terms. Words in blue italics are defined in the glossary; you can access their definitions in a small pop-up window by clicking on them.

Inside and Around the Prostate

The prostate is a gland found only in men. It is about the size of a walnut and is located in front of the rectum, internally, just behind the base of the penis. The prostate surrounds the internal part of the urethra, the tube that carries urine and semen out of the penis.

Fig 1. Location of the Prostate Gland

The function of the prostate gland is to produce some of the seminal fluid (or semen), which protects and nourishes sperm cells. The cells that make up the prostate gland grow and stay healthy because of the influence of the main male hormone, testosterone. A general term for all male hormones is androgens.

Prostate cancer develops from cells of the prostate gland. Almost all prostate cancers are adenocarcinomas, meaning that they develop from glandular cells. Prostate cancer generally grows slowly within the gland, but as it grows, it can eventually penetrate the outer rim of the gland. When this happens it may spread directly to tissues and organs near the prostate gland. Eventually the cancer cells may spread (metastasize) to distant parts of the body, particularly the bones.

IIf it spreads, prostate cancer tends to first go through lymphatic vessels to nearby lymph nodes in the pelvis. Lymph is a clear fluid that contains tissue waste products and immune system cells. Lymphatic vessels carry this fluid to lymph nodes (small, bean-shaped collections of immune system cells that are important in fighting infections). Cancer cells may enter lymphatic vessels and spread out along these vessels toward the lymph nodes, where they can continue to grow. If prostate cancer cells have reached the pelvic lymph nodes, it is likely they have spread to other organs of the body, too.

Surrounding the prostate gland are bundles of nerves and blood vessels. The nerves that run along the outside of the prostate gland help cause an erection of the penis. Treatments that destroy or damage these nerves can cause erectile dysfunction, also known as impotence.

The entire report is also available as a PDF file:

NCCN Prostate Guidelines.pdf 527 k

You will need Adobe Acrobat to read this file.  Click here to download a current version.

EARLY DETECTION

The mutual goal of the National Comprehensive Cancer Network® (NCCN®) and the American Cancer Society (ACS) partnership is to provide patients and the general public with state-of-the-art cancer treatment information in understandable language. This information, based on the NCCN's Clinical Practice Guidelines, is intended to assist you in the dialogue with your physician. These guidelines do not replace the expertise and clinical judgment of your physician. Each patient's situation must be evaluated individually. It is important to discuss the guidelines and all information regarding treatment options with your physician. To ensure that you have the most up-to-date version of the guidelines, consult the web sites of the ACS (www.cancer.org) or NCCN (www.nccn.org). You may also call the NCCN at 1-888-909-NCCN or the ACS at 1-800-ACS-2345 for the most recent information.

NCCN Clinical Practice Guidelines were developed by a diverse panel of experts. The guidelines are a statement of consensus of its authors regarding the scientific evidence and their views of currently accepted approaches to treatment. The NCCN guidelines are updated as new significant data become available. The Patient Information version will be updated accordingly and will be available on-line through the NCCN and the ACS web sites. To ensure you have the most recent version, you may contact the ACS or the NCCN.

© 2007 by the National Comprehensive Cancer Network (NCCN) and the American Cancer Society (ACS). All rights reserved. The information herein may not be reproduced in any form for commercial purposes or downloaded and stored in any information-retrieval system without the express written permission of the NCCN and the ACS. Single copies of each page may be printed out for personal, noncommercial use only.