NCCN Flash Updates: NCCN Guidelines

NCCN has published updates to the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines^®) for Prostate Cancer Early Detection. These NCCN Guidelines^® are currently available as Version 1.2022.

Link directly to the Updates section of the NCCN Guidelines: 
Prostate Cancer Early Detection

PROSD-2

• Baseline evaluation:
  • First bullet, fourth sub-bullet changed: African ancestry to Black/African American identity
  • Sub-bullet added: Environmental exposure
• Risk assessment changed:
  • Age 40–75 y for those with:
    • African ancestry Black/African American individuals

PROSD-2A

• Footnote b revised: Men of African ancestry Black/African American individuals have a higher incidence of prostate cancer, increased prostate cancer, increased prostate cancer mortality, and earlier age of diagnosis compared to Caucasian individuals men. This is attributable to a greater risk of developing preclinical prostate cancer and a higher likelihood that a preclinical tumor will spread. Lack of access to care and other social determinants of health are also associated with poor outcomes in this population. Although There are data suggesting a role for heritable genes linked to Black/African American individuals as African ancestry, it is not known with certainty whether genetics rather than access to health care and other social determinants of health are the main drivers of increased risk in this patient population. Many support the recommendation for Black/African American individuals men of African ancestry to consider beginning shared decision-making about PSA screening at age 40 years and to consider screening at annual intervals rather than every other year. There is no current evidence to support that screening at an earlier age will result in decreased morbidity and mortality compared to testing at age 45, and earlier screening may increase over-diagnosis. Tsodikov A, et al. Cancer 2017;123:2312-2319.
• Footnote d added: Patients with exposure to Agent Orange (eg, many Vietnam War veterans) should be informed that Agent Orange exposure may be associated with an increased risk of high-grade prostate cancer.

PROSD-3

• The algorithm has been divided into two branches under Management for high and low suspicion for clinically significant cancer.
  • Bullet added: High suspicion for clinically significant cancer, with management as, ‘Transrectal ultrasound (TRUS)- or transperineal-guided biopsy with or without MRI targeting’
  • Bullet added: Low suspicion for clinically significant cancer, with management as, ‘Follow-up in 6–12 mo with PSA/DRE’
• Footnote l revised: Biomarkers that improve the specificity of detection are not, as yet, mandated as first-line screening tests in conjunction with serum PSA. However, there may be some patients who meet PSA standards for consideration of prostate biopsy, but for whom the patient and/or the physician wish to further define risk. Percent-free PSA may improve cancer detection. The probability of high-grade cancer (Gleason score ≥ 3+4, Grade Group 2 or higher) may be further defined utilizing the Prostate Health Index (PHI), SelectMDx, 4Kscore, and ExoDx Prostate Test, MyProstateScore (MPS), and IsoPSA. Extent of validation of these tests across diverse populations is variable. It is not yet known how such tests could be applied in optimal combination with MRI as yet.
• Footnote m added: Transperineal biopsy is associated with a lower risk of sepsis and a reduced need for antibiotics compared toTRUS biopsy.
• Footnote n revised: Patients with a persistent and significant increase in PSA should be encouraged to undergo biopsy, including patients with a higher PSA density, even if they have a normal MRI.

PROSD-4

• Footnote s modified: Tests that improve specificity in the post-biopsy setting—including percent-free PSA, 4Kscore, PHI, PCA3, and ConfirmMDx, MPS, and IsoPSA—should be considered in patients thought to be higher risk despite a negative prostate biopsy

Previous updates to the NCCN Guidelines for Prostate Cancer Early Detection can be found in the UPDATES section of the current version.

For the complete updated versions of the NCCN Guidelines, NCCN Guidelines with NCCN Evidence Blocks™, the NCCN Drugs & Biologics Compendium (NCCN Compendium^®), the NCCN Biomarkers Compendium^®, the NCCN Chemotherapy Order Templates (NCCN Templates^®), the NCCN Radiation Therapy Compendium™, and the NCCN Imaging Appropriate Use Criteria (NCCN Imaging AUC™), please visit NCCN.org.

To view the NCCN Guidelines for Patients^®, please visit NCCN.org/patientguidelines.

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