NCCN Guidelines for Patients
Prostate Cancer, Version 1.2016
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 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
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
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