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Guidelines Place Emphasis on Expectant Management of Patients With Prostate Cancer: Presented at NCCN
By Ed Susman
HOLLYWOOD, Fla -- March 10, 2008 -- Doctors writing guidelines for the treatment of prostate cancer said that for most low-risk and intermediate-risk malignancies, expectant management can be the most appropriate approach to treatment.
"We need to consider factors beyond [tumour] stage, Gleason score, and prostate-specific antigen [PSA] levels," said James L. Mohler, MD, Chairman, Department of Urologic Oncology, Roswell Park Cancer Institute, Buffalo, New York.
The new guidelines for prostate cancer were presented here on March 6 at the National Comprehensive Cancer Network (NCCN) 13th Annual Conference: Clinical Practice Guidelines and Quality Cancer Care.
Dr. Mohler said the task force given the charge of updating the treatment algorithm for the 21-member institutions decided to emphasise expectant management -- essentially aggressive surveillance without radiation, chemotherapy, or surgery -- in the 2008 rendition of the treatment suggestions, which are now recognised worldwide.
In low-risk patients -- defined as those men with stage T1 to T2a prostate cancer with a Gleason score of 2 to 6 and PSA level <10 ng/mL -- expectant management should be considered for individuals with <10-year life expectancy as well as for those with 10 or more years of life expectancy.
Doctors should also consider radiation therapy for men with a life expectancy <10 years, either 3-dimensional conformal radiation, intensity modulated radiation therapy, or brachytherapy, Dr. Mohler said.
For men with >10 years of life expectancy, radical prostatectomy with or without pelvic lymph node dissection can also be offered as a choice of treatment, he said. Lymph node dissection should be performed if the predicted probability of lymph node metastases is 7% or greater.
Dr. Mohler said that expectant management should also be offered to men who have a life expectancy of <10 years if they have intermediate-risk prostate cancer -- defined as stage T2b to T2c with an elevated Gleason score of 7 and PSA between 10 to 20 ng/mL. In addition to expectant management, radiation therapy and radical prostatectomy can also be offered within the framework of the guidelines.
However, if patients have >10-year life expectancy with intermediate-risk prostate cancer, doctors and patients should decide between definitive radiation and radical prostatectomy, he said.
Dr. Mohler said that in this group of patients, androgen deprivation therapy has no role in up-front treatment.
[Presentation title: 2008 Update Prostate Cancer Guidelines.]
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