Initial Prostate Cancer Diagnosis:
Regional Risk
Doctors use disease features including (but not limited to) those listed below
to determine prostate cancer risk group.
Patients with an initial diagnosis of cancer spread to nearby lymph nodes – Regional (Stage 4A); Any PSA, Gleason/Grade Group
Treatment Options
5 or Less, No Symptoms
- Observation
- External Beam Radiation Therapy (EBRT)
- Androgen Deprivation Therapy (ADT) + EBRT
5 or more, or Symptomatic
- Androgen Deprivation Therapy (ADT) alone or with abiraterone
- EBRT (External Beam Radiation Therapy) +
- ADT (24 months) + abiraterone (preferred) or
- ADT (24-36 months)
- Radical Prostatectomy (surgery) with Pelvic Lymph Node Dissection (PLND)
- PSA undetectable
- No adverse feature and no lymph node metastases: monitoring PSA every 6-12 months for 5 years then every year
- Adverse feature (s) or lymph node metastases
- Lymph node metastases
- EBRT + ADT
- EBRT + ADT + Abiraterone
- PSA persistence
- Studies negative for pelvic lymph node Positive lymph and distant metastases +/- fossa, no imaging done
- EBRT +/- (preferred)
- Monitoring
- Positive pelvic node recurrence
- EBRT + ADT
- EBRT + ADT + Abiraterone
- Studies negative for pelvic lymph node Positive lymph and distant metastases +/- fossa, no imaging done
- PSA undetectable
CLINICAL TRIALS:
NCCN believes that the best management of any patient with cancer is in a clinical trial. Participation in clinical trials is especially encouraged.
Referenced with permission from the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Prostate Cancer Version 4.2023
© National Comprehensive Cancer Network, Inc. 2022. All rights reserved. The complete and current version of the guideline is available at NCCN.org.
IMPORTANT:
This information is provided for educational purposes only to support patients in understanding and discussing appropriate treatment options with their doctors. Included is information from treatment guidelines for doctors and other sources. However, this information should not be considered as patient treatment guidelines or recommendations, but as educational materials only. Patients should discuss treatments identified herein with their doctors to understand the risks and benefits of each based on their personal diagnosis. Treatment decisions should only be made between the patient and his doctor.