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Very low risk

48

NCCN Guidelines for Patients

®

Prostate Cancer, Version 1.2016

5

Treatment guide: Initial treatment

Very low risk

Guide 3. Primary treatment

Expected years to live

What are the options?

<10 years

Ü

• Observation

10–20 years

Ü

• Active surveillance

◦◦ PSA no more often than every 6 months,

◦◦ DRE no more often than every 12 months, and

◦◦ Prostate biopsy no more often than every 12 months

◦◦ Consider mpMRI to help stage and grade the cancer if PSA

increases and biopsy samples had no cancer

≥20 years

Ü

• Active surveillance

◦◦ PSA no more often than every 6 months,

◦◦ DRE no more often than every 12 months, and

◦◦ Prostate biopsy no more often than every 12 months

◦◦ Consider mpMRI to help stage and grade the cancer if PSA

increases and biopsy samples had no cancer

Ü

• Radiation therapy

◦◦ EBRT

◦◦ LDR brachytherapy

Ü

• Surgical treatment

◦◦ Radical prostatectomy

◦◦ Radical prostatectomy + PLND if ≥2% risk of cancer in lymph nodes

Guide 3

lists the treatment options for men at

very low risk of recurrence. The criteria for very

low risk include a T1c tumor. This tumor can’t be

felt with a DRE but is found because of high PSA

levels. NCCN experts are concerned about over-

treatment of this early cancer.

Observation

NCCN experts advise starting observation if

you’re expected to live less than 10 years.

The cancer may never cause any problems.

Observation consists of testing on a regular basis

so that supportive care with ADT can be given if

symptoms from the cancer are likely to start. Tests

during observation include PSA and DRE.