Prostate Cancer Clinical Practice Guidelines (2019)

National Comprehensive Cancer Network

This is a quick summary of the guidelines without analysis or commentary. For more information, go directly to the guidelines by clicking the link in the reference.

June 05, 2019

The guidelines on prostate cancer were released on May 1, 2019, by the National Comprehensive Cancer Network.[1]

NCCN recommendations are as follows:

Patients with regional or metastatic prostate cancer and those with localized prostate cancer and a suspicious family history should undergo germline testing for the following genes associated with an increased incidence and/or aggressiveness of prostate cancer: MLH1; MSH2; MSH6; PMS2 (for Lynch syndrome); and the homology-directed repair genes BRCA1, BRCA2, ATM, PALB2, and CHEK2. Next-generation sequencing can be used.

As a higher incidence of germline mutations is found in intraductal cancers, and such mutations can have treatment implications, patients with intraductal prostate cancer should undergo germline testing.

Patients with intermediate-risk disease are categorized as favorable vs unfavorable risk. Active surveillance may be appropriate for some favorable intermediate-risk patients with expected survival of 10 years or longer.

Intermittent androgen deprivation therapy (ADT) is considered as safe as continuous ADT for men with nonmetastatic prostate cancer. Intermittent ADT should be considered in men with metastatic disease.

Treatment of the primary tumor is controversial in men with low-volume metastatic prostate cancer.

Second-generation androgen receptor blockers are recommended in addition to ADT for patients with nonmetastatic castration-resistant prostate cancer and a prostate specific antigen doubling time of 10 months or less.

For more information, see Prostate Cancer and Prostate Cancer Treatment Protocols. For more Clinical Practice Guidelines, please go to Guidelines.

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