NCCN Guidelines For Prostate Cancer Updated To Stress Careful Consideration Of Active Surveillance- Medical News Today
11 Jan 2010
The National Comprehensive Cancer Network (NCCN) recently updated the NCCN Clinical Practice Guidelines for Oncology™ for Prostate Cancer to reflect new recommendations regarding active surveillance, also referred to as watchful waiting, for men with low risk prostate cancer.
A significant change incorporated into the updated NCCN Guidelines for Prostate Cancer is the recommendation for active surveillance and only active surveillance for many men diagnosed with prostate cancer. Men with low risk prostate cancer who have a life expectancy of less than 10 years should be offered and recommended active surveillance.
In addition, a new “very low risk” category has been added to the updated NCCN Guidelines using a modification of the Epstein criteria for clinically insignificant prostate cancer. Only active surveillance is offered and recommended for men in this category when life expectancy is less than 20 years.
“The NCCN Prostate Cancer Guideline Panel and the NCCN Prostate Cancer Early Detection Panel remain concerned about over-diagnosis and over-treatment of prostate cancer,” says James L. Mohler, MD, of Roswell Park Cancer Institute and chair of the NCCN Guidelines Panel for Prostate Cancer. “Growing evidence suggests that over-treatment of prostate cancer commits too many men to side effects that outweigh a very small risk of prostate cancer death.”
The NCCN Guidelines Panel took careful consideration, including a thorough review of evolving data, of which men should be recommended for active surveillance. The updated NCCN Guidelines now recommend active surveillance for men with very low risk prostate cancer and life expectancy estimated at less than 20 years or men with low risk prostate cancer and life expectancy estimated at less than 10 years.
“Although the NCCN Guidelines Panel stresses the importance of considering active surveillance, ultimately this decision must be based on careful individualized weighting of a number of factors including life expectancy, disease characteristics, general health condition, potential side effects of treatment, and patient preference,” notes Dr. Mohler. “It is an option that needs to be thoroughly discussed with the patient and all of his physicians which may include his urologist, radiation oncologist, medical oncologist, and primary care physician.”
The updated NCCN Guidelines stress that active surveillance involves actively monitoring the course of the disease with the expectation to intervene if the cancer progresses. Patients under active surveillance must commit to a regular schedule of follow-up, which includes a prostate exam and PSA, and which may include repeat prostate needle biopsies.
The NCCN Clinical Practice Guidelines in Oncology™ are developed and updated through an evidence-based process with explicit review of the scientific evidence integrated with expert judgment by multidisciplinary panels of physicians from NCCN Member Institutions. The most recent version of this and all the NCCN Guidelines are available free of charge at NCCN.org.
National Comprehensive Cancer Network
I have patients tell me all the time they want to “do nothing.” The problem with most who say this is that they are thinking this before the biopsy or the knowledge of prostate cancer exists. In other words, they have heard of active surveillance and the slow-growing nature of prostate cancer and are using this as an argument not to have the biopsy in the first place. You have to know the specifics of the cancer in addition to your overall medical condition and life expectancy to adequately determine if you are a candidate. In general as stated in the article above, favorable parameters of the biopsy and life expectancy of less than ten years make for a good candidate for surveillance. I might add, that for me it was not an option as I was relatively young with a long life expectancy but my mentality was not suitable in this case for doing nothing. I couldn’t just do nothing knowing that there was “something in me.”