NCCN Guidelines for Patients
Prostate Cancer, Version 1.2016
Treatment guide: Initial treatment
If you are expected to live 10 or more years, a
radical prostatectomy is a second option. Your pelvic
lymph nodes may also be removed if your risk for
them having cancer is 2% or higher. Your doctor will
determine your risk using a nomogram, which was
described in Part 3.
The tissue that will be removed from your body during
the operation will be sent to a pathologist. He or she
will assess how far the cancer has spread within the
tissue. After the operation, your PSA level will also be
You may receive more treatment after surgery. Read
Guide 7 for more information.
Some research suggests that active surveillance can
be an option for a subset of men with intermediate-
risk cancer. The subset includes men with:
1) Cancer that is mostly Gleason grade 3,
2) Cancer in less than half of the core biopsies,
3) Only one condition listed on page 46 for
Active surveillance may be considered in this subset
of men who will likely live 10 or more years. MRI and
molecular testing may assist in the decision to start
active surveillance in this group.
Active surveillance is described on page 50. Ask your
doctor about the pros and cons of active surveillance
for intermediate-risk cancer. Your doctor may want
you to be tested more often to quickly detect any
change in cancer status.