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NCCN Guidelines for Patients


Prostate Cancer, Version 1.2016


Treatment planning

Risk assessment

Risk assessment

To plan the best treatment for you, your doctors will

like to know:

• If and how far the cancer has spread,

• How fast the cancer will grow,

• How the cancer will respond to treatment, and

• Whether cancer will re-appear on tests after

treatment (called a recurrence).

However, this information often can only be known

over time or after cancer treatment has started.

As such, your doctors will assess your chances

(also called risk) for such events. Risk groups and

nomograms are two tools that doctors use. Molecular

testing is a newer tool that needs more research.

Risk groups

Risk groups divide people with cancer into smaller

subsets based on their chances of an event. Some

risk groups are based on one piece of information

while others use multiple pieces of information. In

Part 5, treatment options are presented by risk groups

for prognosis. Risk is based on TNM scores, Gleason

score, and PSA values. NCCN experts recommend

that these risk groups be used as a foundation to start

talking about treatment options.


A nomogram uses data from a large number of men

and complex math to predict risk. It can predict one

person’s risk better than a risk group. A nomogram

predicts an event by taking into account similarities

and differences among pieces of information. In

this book, test and treatment recommendations are

sometimes based on nomograms that predict how

likely the cancer has spread to lymph nodes. Also,

NCCN experts advise that nomograms be used

in addition to risk groups to better plan treatment.

Websites with information on nomograms are listed in

Part 8.

Molecular testing

Any of your body’s molecules that can be measured

to assess your health is called a biomarker. An

example of a biomarker is PSA for detecting prostate

cancer. There are also biomarkers for predicting how

fast cancer will grow and treatment results. Molecular

(or biomarker) testing assesses for such biomarkers.

There are several molecular tests that may help

assess how aggressive localized prostate cancer is.

Localized cancer includes tumors that have not grown

through the prostate and into nearby structures.

There is also no spread to nearby lymph nodes or

distant sites.

Molecular testing is performed on prostate tissue

removed by biopsy or surgery at diagnosis. It can

be considered when active surveillance is an option.

Molecular tests should be used with standard tests

including PSA, Gleason grade, cancer stage, and


No molecular test of prostate cancer has been

assessed in a well-designed research study. Such

studies would assign men to research groups by

chance. Also, molecular testing would be done first

and then outcomes would be assessed over time.

Without such studies, there are major limits to how

useful molecular tests are for making treatment


The Decipher test, Prolaris test, and Oncotype DX

have been approved by the Molecular Diagnostic

Services Program in certain cases. Still, more

research is needed. Several other tests are under