Initial Prostate Cancer Diagnosis:
Very High Risk
Doctors use disease features including (but not limited to) those listed below
to determine prostate cancer risk group.
Patients with an initial diagnosis that includes one of the following: Gleason 9-10/Grade Group 5, tumor has spread to nearby organs.
Treatment Options
5 or Less & No Symptoms
Observation: Monitoring with PSA every 6–12 months, or
Androgen Deprivation Therapy (ADT), or
External Beam Radiation Therapy (EBRT)
5+ or Symptoms
EBRT with ADT (1.5 – 3 years), or
EBRT + Brachytherapy + ADT (1 – 3 years), or
EBRT +ADT (2y) + abiraterone
Radical Prostatectomy (surgery) with Pelvic Lymph Node Dissection (PLND)
With no adverse features or lymph node metastases: Monitoring with PSA every 6-12 months for 5 years then every year.
With adverse features detected but no lymph metastasis:
EBRT, or
EBRT with Androgen Deprivation Therapy (ADT), or
Monitoring with consideration of early radiation therapy (RT) for a detectable and rising PSA or PSA >0.1 ng/ml
With lymph node metastasis:
ADT, or
ADT with EBRT, or
Monitoring with consideration of early radiation therapy (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.
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.