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. The NCCN guidelines, based on scientific data, are the most widely used standards for cancer care.
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 Guidelines 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, Chair of the 23-member NCCN Panel for Prostate Cancer and Chair, Urology and Senior Vice President, Translational Research at Roswell Park Cancer Institute (RPCI). “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.
RPCI's Michael Kuettel, MD, PhD, Barbara C. and George H. Hyde Chair in Radiation Medicine, also serve on the NCCN Prostate Guidelines Panel.
“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.
Donald L. Trump, MD, FACP, President and CEO of RPCI, remarked, “With three of our faculty members on the NCCN committee, Roswell Park has played a major leadership role in developing the new treatment guidelines for prostate cancer. NCCN disease-specific guidelines, which derive from evidence-based medicine, help patients sort out their treatment options and drive important decisions.”
RPCI's Dr. Michael Kuettel said, “When a diagnosis of cancer is made, it's important not to panic. We hope the new guidelines help put elevated PSA levels in perspective and that patients will not rush into any treatments without a careful consideration of their options. Roswell Park provides a variety of treatment choices to patients through our multidisciplinary approach.”
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 http://www.NCCN.org.
About the National Comprehensive Cancer Network: The National Comprehensive Cancer Network (NCCN), a not-for-profit alliance of 21 of the world's leading cancer centers, is dedicated to improving the quality and effectiveness of care provided to patients with cancer. Through the leadership and expertise of clinical professionals at NCCN Member Institutions,
NCCN develops resources that present valuable information to the numerous stakeholders in the health care delivery system. As the arbiter of high-quality cancer care, NCCN promotes the importance of continuous quality improvement and recognizes the significance of creating clinical practice guidelines appropriate for use by patients, clinicians, and other health care decision-makers. The primary goal of all NCCN initiatives is to improve the quality, effectiveness, and efficiency of oncology practice so patients can live better lives.
The NCCN Member Institutions are: City of Hope Comprehensive Cancer Center, Los Angeles, CA; Dana-Farber/Brigham and Women's Cancer Center | Massachusetts General Hospital Cancer Center, Boston, MA; Duke Comprehensive Cancer Center, Durham, NC; Fox Chase Cancer Center, Philadelphia, PA; Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT; Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance, Seattle, WA; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL; Memorial Sloan-Kettering Cancer Center, New York, NY; H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL; The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute, Columbus, OH; Roswell Park Cancer Institute, Buffalo, NY; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine, St. Louis, MO; St. Jude Children's Research Hospital/University of Tennessee Cancer Institute, Memphis, TN; Stanford Comprehensive Cancer Center, Stanford, CA; University of Alabama at Birmingham Comprehensive Cancer Center, Birmingham, AL; UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; UNMC Eppley Cancer Center at The Nebraska Medical Center, Omaha, NE; The University of Texas M. D. Anderson Cancer Center, Houston, TX; and Vanderbilt-Ingram Cancer Center, Nashville, TN.
About Roswell Park Cancer Institute: The mission of Roswell Park Cancer Institute (RPCI) is to understand, prevent and cure cancer. RPCI, founded in 1898, was one of the first cancer centers in the country to be named a National Cancer Institute-designated comprehensive cancer center and remains the only facility with this designation in Upstate New York. The Institute is a member of the prestigious National Comprehensive Cancer Network, an alliance of the nation's leading cancer centers; maintains affiliate sites; and is a partner in national and international collaborative programs. For more information, visit RPCI's website at http://www.roswellpark.org, call 1-877-ASK-RPCI (1-877-275-7724) or email firstname.lastname@example.org.
For more information on the guidelines, visit www.nccn.org.
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