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NCCN Guidelines for Patients


Prostate Cancer, Version 1.2016


Treatment guide: Initial treatment

Low risk

Guide 5

lists options for adjuvant treatment after a

prostatectomy. Adjuvant treatment helps to stop the

cancer from returning.

Options are based on the presence of high-risk

features and cancer in the lymph nodes. High-risk

features suggest that not all of the cancer was

removed by the operation. High-risk features include:

• Cancer in surgical margins,

• Cancer outside the prostatic capsule,

• Cancer in the seminal vesicle(s), and

• Detectable PSA levels.

If test results find no high-risk features or cancer in

the lymph nodes, no more treatment is needed. You

may start observation.

EBRT or observation is an option for when there

are high-risk features but no cancer in lymph nodes.

EBRT will target areas where the cancer cells have

likely spread. Treatment will be started after you’ve

healed from the prostate operation.

There are two treatment options if cancer is found

in lymph nodes. The first option is to start ADT now.

EBRT may be given with ADT. If your PSA levels are

undetectable, a second option is to start observation.

Supportive care with ADT can be started if the levels


For adjuvant ADT, an LHRH antagonist or LHRH

agonist is advised. It can be given on an intermittent

schedule to reduce its side effects. However, the

benefits of ADT in this case are unclear.