Updated NCCN guidelines stress active surveillance for low-risk PCa

Men with low-risk prostate cancer who have a life expectancy of less than 10 years should be offered and recommended active surveillance, according to updated guidelines from the National Comprehensive Cancer Network (NCCN).

The NCCN’s Clinical Practice Guidelines for Oncology for Prostate Cancer reflect new recommendations regarding active surveillance for men with low-risk prostate cancer.

A new "very low-risk" category also has been added to the updated guidelines using a modification of the Epstein criteria for clinically insignificant prostate cancer. Active surveillance should be offered and recommended for men in this category only when life expectancy is less than 20 years.

"The NCCN Prostate Cancer Guideline Panel and the NCCN Prostate Cancer Early Detection Panel remain concerned about over-diagnosis and over-treatment of prostate cancer," said James L. Mohler, MD, of Roswell Park Cancer Institute, Buffalo, NY, and chair of the NCCN Guidelines Panel for Prostate Cancer. "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."

"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. 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."