Initial Prostate Cancer Diagnosis:
Very Low 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 PSA less than 10, Gleason 6/Grade Group 1, and less than 3 biopsy cores positive for cancer. Cancer found by needle biopsy and cannot be felt during exam.
Treatment Options
Less Than 10
Observation: History and physical exam every 12 months or as needed
- PSA every 6–12 months for 5 years, then every year
- DRE if suspicion of recurrence
10-20
Active Surveillance: PSA every 6 months, DRE, repeat biopsy, and repeat multi-parametric magnetic resonance imaging (mpMRI) every 12 months or as needed.
20 or More
Active surveillance (preferred)
External beam radiation therapy (EBRT)
Brachytherapy
Radical Prostatectomy (surgery) *With concerning features following surgery: EBRT, or EBRT with Androgen Deprivation Therapy (ADT), or Monitoring with consideration of early radiation (RT) for a detectable and rising PSA or PSA >0.1 ng/ml
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.
NOTE:
For asymptomatic patients in very low, low, and intermediate, risk groups with life expectancy less than 5 years no imaging or treatment is indicated until patient becomes symptomatic.
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.
