CARCINOMA PROSTATE--1

Active Surveillance

• Localized prostate cancer patients who elect active surveillance should have accurate disease staging including systematic biopsy with ultrasound or MRI guided imaging (Clinical Principle) 

• Localized prostate cancer patients undergoing active surveillance should have routine surveillance PSA (prostate specific antigen) testing and DRE (digital rectal examination) (Strong Recommendation; Evidence Level: Grade B) 

• Localized prostate cancer patients undergoing active surveillance should be encouraged to have a confirmatory biopsy within the initial two years and surveillance biopsies thereafter (Clinical Principle) 

• Clinicians may consider multiparametric prostate MRI as a component of active surveillance for localized prostate cancer patients (Expert Opinion)

• Tissue based genomic biomarkers have not shown a clear role in active surveillance for localized prostate cancer and are not necessary for follow-up (Expert Opinion) 

• Clinicians should offer definitive treatment to localized prostate cancer patients undergoing active surveillance who develop adverse reclassification (Moderate Recommendation; Evidence Level: Grade B)

Prostatectomy

• Clinicians should inform localized prostate cancer patients that younger or healthier men (e.g., 10 year life expectancy) are more likely to experience cancer control benefits from prostatectomy than older men (Strong Recommendation; Evidence Level: Grade B) 

• Clinicians should inform localized prostate cancer patients that open and robot-assisted radical prostatectomy offer similar cancer control, continence recovery, and sexual recovery outcomes (Moderate Recommendation; Evidence Level: Grade C) 

• Clinicians should inform localized prostate cancer patients that robotic/laparoscopic or perineal techniques are associated with less blood loss than retropupic prostatectomy (Strong Recommendation; Evidence Level: Grade B) 

• Clinicians should counsel localized prostate cancer patients that nerve sparing is associated with better erectile function recovery than non-nerve sparing (Strong Recommendation; Evidence Level: Grade A) 

• Clinicians should not treat localized prostate cancer patients who have elected to undergo radical prostatectomy with neoadjuvant androgen deprivation therapy (ADT) or other systemic therapy outside of clinical trials (Strong Recommendation; Evidence Level: Grade A) 

• Clinicians should inform localized prostate cancer patients considering prostatectomy, that older men experience higher rates of permanent erectile dysfunction and urinary incontinence after prostatectomy compared to younger men (Strong Recommendation; Evidence Level: Grade B)

• PLND (pelvic lymphadenectomy) can be considered for any localized prostate cancer patients undergoing radical prostatectomy and is recommended for those with unfavorable intermediate risk or high risk disease. Patients should be counseled regarding the common complications of lymphadenectomy, including lymphocele development and its treatment (Expert Opinion) 

• Clinicians should inform localized prostate cancer patients with unfavorable intermediate risk or high risk prostate cancer about benefits and risks related to the potential option of adjuvant radiotherapy when locally extensive prostate cancer is found at prostatectomy (Moderate Recommendation; Evidence Level: Grade B)

Read about the guidlines in detail here

Compiled by:
Newsfeed Desk