We have now had the chance to look carefully through the new, patient-specific guidelines on prostate cancer issued by the National Comprehensive Cancer Network (NCCN) just before the Holidays. They are not perfect, but they are certainly a vast improvement over the NCCN’s first attempt.
On the good side:
- It gives a sound introduction to the benefits and risks of individual testing (“screening”) for risk of prostate cancer, making it very clear that testing should be an individualized decision based on factors such as personal risk, ethnicity, and the desires of the patient.
- It gives a good overview of all of the major management options, and places significant emphasis on the potential value of active surveillance, most particularly for those men with low- and very low-risk disease
- It includes good, basic information on the side effects and complications of all the various treatment options.
- It has sections dealing with such important factors as
- Talking to one’s doctors
- Seeking second opinions
- Involving one’s spouse/partner in the decision process
- Diet and exercise
- Recognizing that caregivers also need care
On the down side, those who have particular views about specific types of treatment will be disappointed by the fact that:
- It includes no information about proton beam radiation therapy, stating, “These NCCN Guidelines don’t recommend EBRT with proton beams at this time. Research hasn’t shown proton beams to be the same or better for prostate cancer than photon beams and conventional external beams.”
- There is no reference to high-intensity focused ultrasound (HIFU).
- There is no reference to any form of focal therapy (using methods like cryotherapy or HIFU).
- It doesn’t get into any detail about complementary and alternative forms of management (with supplements and other nutritional factors).
- There is no discussion of intermittent androgen deprivation therapy (IADT) as a form of therapy for systemic forms of prostate cancer (metastatic and micrometastatic disease), although it is defined.
- There is no discussion of the relative merits of single-agent ADT as compared to combined ADT or ‘triple” ADT.
The booklet — which is 100 pages long — does contain, however, a thorough glossary of relevant prostate cancer terminology, recommended questions to ask one’s doctors (about testing, about treatment, and about clinical trials), and all of the usual base information about development of prostate cancer, the staging and grading processes, and other core information.
On the whole, although there are some flaws, The “New” Prostate Cancer InfoLink feels that this booklet is a valuable one that can be strongly recommended to any man who is looking for a sound, basic introduction to prostate cancer.
It is well laid out and comes with numerous illustrations and tables. It is relatively simple and easy to read and follow. And of course it comes with the added benefit that it is freely available on line and that copies of the printed booklet can be ordered at no cost from the NCCN too.