1、Version 2.2014, 04/01/14 National Comprehensive Cancer Network, Inc. 2014, All rights reserved. The NCCN Guidelines and this illustration may not be reproduced in any form without the express written permission of NCCN . NCCN Guidelines Index Prostate Table of Contents Discussion NCCN Guidelines Ver
2、sion 2.2014 Prostate Cancer NCCN.org Continue NCCN Clinical Practice Guidelines in Oncology (NCCN Guideline ) Prostate Cancer Version 2.2014 NCCN Guidelines for Patients available at www.nccn.org/patientsVersion 2.2014, 04/01/14 National Comprehensive Cancer Network, Inc. 2014, All rights reserved.
3、The NCCN Guidelines and this illustration may not be reproduced in any form without the express written permission of NCCN . NCCN Guidelines Index Prostate Table of Contents Discussion NCCN Guidelines Version 2.2014 Prostate Cancer Diagnostic interventional radiology Radiotherapy/Radiation oncology
4、Urology Medical oncology Supportive care, including palliative, pain management, pastoral care, and oncology social work *Writing committee member Pathology NCCN Guidelines Panel Disclosure NCCN Maria Ho, PhD Dorothy A. Shead, MS Continue James L. Mohler, MD/Chair Roswell Park Cancer Institute Phili
5、p W. Kantoff, MD/Vice Chair Dana-Farber/Brigham and Womens Cancer Center | Massachusetts General Hospital Cancer Center The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute Michael Cohen, MD Huntsman Cancer Institute at the University of Utah An
6、thony Victor DAmico, MD, PhD Dana-Farber/Brigham and Womens Cancer Center | Massachusetts General Hospital Cancer Center James A. Eastham, MD Memorial Sloan-Kettering Cancer Center Charles A. Enke, MD Fred added ( ). Changed the order of the tests. Added . Following bone scan added ( . Added footnot
7、e j to Observation. Changed Post-radiation therapy recurrence to . Changed the order of the tests. Changed prostate biopsy to . Changed endorectal MRI to . Added . Added . Added footnote j to Observation. Radical Prostatectomy Biochemical Failure. Radical Prostatectomy Biochemical Failure PSA recurr
8、ence C-11 choline PET methylene diphosphonate MDP or sodium flouride NaF) Radiation Therapy Recurrence TRUS biopsy prostate MRI C-11 choline PET Observation Initial management or pathology, N1 or M1, monitoring; removed (including DRE). Post-RP recurrence, failure of PSA to fall to undetectable leve
9、ls; added ( ). Post-RP recurrence, undetectable PSA after RP with a subsequent detectable PSA that increases on 2 or more determinations; added () . Failure of PSA to fall to undetectable levels; added (PSA persistence). PSA persistence PSA recurrence Continued on next page PROS-9 PROS-10 PROS-11 PR
10、OS-B Added . Added footnote j to Observation. Added footnote b, . Changed steroids to . Replaced footnote: “Frequency of imaging should be based on individual risk, age, PSADT, Gleason score, and overall health” with “ Observation corticosteroids See Principles of Imaging (PROS-B) See Principles of
11、Imaging (PROS-B) Studies negative for metastases Observation Secondary hormone therapy, added . Studies positive for metastases Added as an option for symptomatic CRPC. This is a new page, Principles of Imaging. distant especially if PSADT 10 mo especially if PSADT 10 mo distant Best supportive care
12、 .” Printed by chen dongning on 9/30/2014 6:28:34 AM. For personal use only. Not approved for distribution. Copyright 2014 National Comprehensive Cancer Network, Inc., All Rights Reserved.Version 2.2014, 04/01/14 National Comprehensive Cancer Network, Inc. 2014, All rights reserved. The NCCN Guideli
13、nes and this illustration may not be reproduced in any form without the express written permission of NCCN . NCCN Guidelines Index Prostate Table of Contents Discussion NCCN Guidelines Version 2.2014 Prostate Cancer Updates Note: All recommendations are category 2A unless otherwise indicated. Clinic
14、al Trials: NCCN believes that the best management of any cancer patient is in a clinical trial. Participation in clinical trials is especially encouraged. UPDATES PROS-C 1 of 2 PROS-C 2 of 2 Changed PSA at least as often as every 6 mo to . Changed DRE at least as often as every 12 mo to “DRE no more
15、 often than every 12 mo unless clinically indicated.” Added: Avoidance of possible side effects of unnecessary definitive therapy and early initiation and/or continuous ADT. Added: PSA no more often than every 6 mo unless clinically indicated Advantages of observation: Disadvantages of observation:
16、Risk of urinary retention or pathologic fracture without prior symptoms or concerning PSA level. Added the following bullet: . Modified the third bullet: Active surveillance is for men with very low-risk prostate cancer and life expectancy 20 y. Added the following bullet: Modified the sixth bullet
17、for consistency: Removed: Needle biopsy may be performed within 18 mo if initial prostate biopsy 10 cores and as often as every 12 mo. Modified the statement: Repeat prostate biopsies are not indicated when life expectancy is 100 ng/mL) in observation patients, who will then begin palliative ADT pre
18、ferred Observation is preferred for men with low-risk prostate cancer with life expectancy 10 y. . Observation involves monitoring the course of disease with the expectation to deliver palliative therapy for the development of symptoms or change in exam or PSA levels that suggest symptoms are immine
19、nt. or appropriate when men are on observation See Risk Group Criteria (PROS-2) PROS-D 1 of 2 Primary External Beam Radiation Therapy (EBRT): Added the following bullet: . Added the following bullet: Modified bullet: Moderately hypofractionated image- guided IMRT regimens (2.4 to 4 Gy per fraction o
20、ver 4 to 6 weeks) have been tested in randomized trials reporting similar efficacy and toxicity to conventionally fractionated IMRT. They can be considered as an alternative to conventionally fractionated regimens when clinically indicated Extremely hypofractionated image- guided IMRT/SBRT regimens
21、(6.5 Gy per fraction or greater) are an emerging treatment modality with single institutional and pooled reports of similar efficacy and toxicity to conventionally fractionated regimens. They can be considered as a cautious alternative to conventionally fractionated regimens at clinics with appropri
22、ate technology, physics, and clinical expertise.” Removed: “Treatment results appear better when disease burden is lower. Radiation should be administered before PSA exceeds 0.5 ng/mL. Primary/Salvage Brachytherapy First bullet: changed 4-6 mo ADT to 2-3 y neoadjuvant/concomitant/adjuvant ADT. Modif
23、ied bullet: Patients with a very large prostate or very small prostate, symptoms of bladder outlet obstruction (high IPSS), or a previous transurethral resection of the prostate are more difficult to implant and may suffer increased risk of side effects. Neoadjuvant ADT may be used to shrink the pro
24、state to an acceptable size; however, increased toxicity would be expected from the ADT and prostate size may not decline. High-dose rate (HDR) brachytherapy can be used in combination with EBRT (40-50 Gy) instead of LDR. Commonly used boost regimens include 9.5 to 11.5 Gy x 2 fractions, 5.5 to 7.5
25、Gy x 3 fractions, and 4.0 to 6.0 Gy x 4 fractions. alone or A commonly used regimen for HDR treatment alone include 13.5 Gy x 2 fractions. Continued on next page Printed by chen dongning on 9/30/2014 6:28:34 AM. For personal use only. Not approved for distribution. Copyright 2014 National Comprehensive Cancer Network, Inc., All Rights Reserved.
