NCCN Guidelines for Patients
Prostate Cancer, Version 1.2016
Treatment guide: Initial treatment
Guide 4. Primary treatment
Expected years to live
What are the options?
• 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
• Radiation therapy
◦◦ LDR brachytherapy
• Surgical treatment
◦◦ Radical prostatectomy
◦◦ Radical prostatectomy + PLND if ≥2% risk of cancer in lymph nodes
lists the treatment options for men at low
risk of recurrence. The criteria for low risk include
T1 and T2a tumors. Treatment options are based on
how many years a man is expected to live.
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.
Active surveillance is an option if you are likely to
live more than 10 years. Active surveillance consists
of testing on a regular basis so that treatment can
be started when needed. Treatment is given when
there is still an excellent chance for a cure.
Active surveillance consists of multiple tests. In
general, PSA testing should occur no more often
than every 6 months. DRE should occur no more
often than every 12 months.
Doctors don’t agree on the need for and frequency
of repeat biopsies. Some doctors do repeat biopsies