NCCN Guidelines for Patients
Prostate Cancer, Version 1.2016
Treatment guide: Initial treatment
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.