NCCN Guidelines For Patients®: Prostate Cancer (2018).pdf

NCCN Guidelines Summary (Version 4.2018)

This summary outlines key points from the National Comprehensive Cancer Network (NCCN) guidelines for prostate cancer, Version 4.2018.

Initial Diagnosis & Risk Stratification:

Clinical trials are strongly encouraged for all patients with prostate cancer.
Prostate cancer is categorized into risk groups based on PSA level, tumor stage, and other factors. These groups guide treatment recommendations.

Treatment Recommendations by Risk Group:

Very Low Risk: Active surveillance or watchful waiting often recommended.

Low Risk: Watchful waiting or active surveillance, with consideration for surgery or radiation if symptoms develop.

Favorable Intermediate Risk: Consideration for active treatment such as surgery, radiation, hormone therapy (ADT), or immunotherapy.

Unfavorable Intermediate & High/Very High Risk: Typically require aggressive treatment including:

Surgery: Radical prostatectomy
Radiation Therapy: External beam radiation therapy (EBRT)
Hormone Therapy (ADT): Androgen deprivation therapy to shrink the tumor and slow progression.
Systemic Therapy: Chemotherapy, targeted therapy (e.g., abiraterone, enzalutamide), or immunotherapy for advanced disease.

Regional & Distant Metastases:

Treatment approaches adjust based on the specific sites of metastasis (e.g., bone, liver).
Newer therapies like abiraterone and enzalutamide are recommended for certain patients with metastatic disease.

Monitoring & Follow-up:

Regular PSA testing, digital rectal exams, and imaging are crucial for monitoring response to treatment and detecting recurrence.

Specific Treatment Details:

Surgery: Includes radical prostatectomy, with varying approaches based on tumor characteristics.
Radiation Therapy: EBRT techniques and combinations with ADT are detailed.
Hormone Therapy (ADT): Explains different types of hormone therapy, including traditional drugs and newer agents like abiraterone and enzalutamide.
Systemic Therapy: Covers chemotherapy, targeted therapies, and immunotherapies used in advanced disease.

Key Updates in Version 4.2018:

Incorporation of new systemic therapy options, including abiraterone and enzalutamide, for various risk groups and metastatic settings.
Refinements to radiation therapy recommendations, including the addition of abiraterone and methylprednisolone in specific scenarios.

Important Considerations:

These guidelines are based on expert consensus and clinical evidence.
Individual patient factors should be considered when determining treatment plans.
Patients should discuss these guidelines with their healthcare team for personalized care.