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50

NCCN Guidelines for Patients

®

Prostate Cancer, Version 1.2016

5

Treatment guide: Initial treatment

Low risk

Low risk

Guide 4. Primary treatment

Expected years to live

What are the options?

<10 years

Ü

• Observation

>10 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 4

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.

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.

Active surveillance

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