The National Comprehensive Cancer Consortium (NCCN) has just released its updated 2016 guidelines on the management of prostate cancer for physicians. The list of changes to the guidelines from the 2015 guidelines are given on slides 4 through 7 of the new guidelines. We have not yet had the chance to review these changes in detail.
For those who are interested in reviewing new 2016 guidelines for themselves, you do have to register with the NCCN to get access to these guidelines, but there is no cost involved.
Filed under: Management, Treatment, Uncategorized | Tagged: guidelines, Management, NCCN, Treatment |
THE "NEW" PROSTATE CANCER INFOLINK 
I’ve had a chance to look at them. In my estimation, the biggest changes from last year were:
(a) New risk groups: as expected, they subdivided intermediate risk prostate cancer into “favorable” and “unfavorable” categories. “Favorable intermediate risk” is defined as intermediate risk with Gleason score of 3 + 4 and percent positive biopsy cores < 50% and no more than one intermediate-risk factor (Gleason score, stage or PSA). NCCN endorses active surveillance as an option for favorable intermediate-risk men but not for unfavorable intermediate-risk. They didn't yet give them their own subsections (as they do for low-risk and high-risk), however.
(b) Docetaxel + ADT has been added as an initial treatment option for all high-risk or very high-risk men, regardless of metastases. It has also been added for all hormone-sensitive men with distant metastases, although they note the benefit is less certain for low volume metastases.
(c) Intermittent ADT is an option for hormone-sensitive men regardless of metastatic status.
(d) EBRT + ADT has been elevated to the preferred initial treatment option (over just ADT) for men diagnosed with positive lymph nodes but no distant metastasis.
(e) Estrogen has been added as a treatment option for metastatic, castrate-resistant men.