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Guide 6. Primary treatment

Expected years to live

What are the options?

<10 years

Ü

• Observation

Ü

• Radiation therapy

◦◦ EBRT ± brachytherapy ± ADT for 4–6 months

◦◦ LDR

brachytherapy alone for low-volume disease

>10 years*

Ü

• Surgical treatment

◦◦ Radical prostatectomy

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

Ü

• Radiation therapy

◦◦ EBRT ± brachytherapy ± ADT for 4–6 months

◦◦ LDR brachytherapy alone for low-volume disease

*Men with “favorable” cancer may start active surveillance but more research on outcomes is needed.

54

NCCN Guidelines for Patients

®

Prostate Cancer, Version 1.2016

5

Treatment guide: Initial treatment

Intermediate risk

Intermediate risk

Guide 6

lists the treatment options for men in the

intermediate risk group. The criteria for intermediate

risk include T2b and T2c tumors. Treatment options

are based on how many years a man is expected to

live.

Observation

Observation is an option for men expected to live

less than 10 years. The cancer is unlikely to cause

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.

Radiation therapy

A treatment option for all men with intermediate

risk is radiation therapy. Research has shown

that EBRT alone often controls intermediate-risk

prostate cancer. LDR or HDR brachytherapy can

be used with EBRT for intermediate-risk cancers

but will likely cause more side effects. LDR

brachytherapy alone may be given if test results

suggest the cancer hasn’t spread far.

Your doctor may want to add a short course of ADT

to EBRT. Research has shown that adding ADT can

extend life. For ADT, an LHRH antagonist or LHRH

agonist may be used. However, doctors often use

CAB, which includes an antiandrogen. If you will

receive ADT, it will be given before, during, and

after radiation therapy for 4 to 6 months.