Prostate Cancer, Version 1.2014 (original) (raw)
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Prostate Cancer, Version 1.2016
Journal of the National Comprehensive Cancer Network, 2016
The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines ®) are a statement of consensus of the authors regarding their views of currently accepted approaches to treatment. The NCCN Guidelines ® Insights highlight important changes to the NCCN Guidelines ® recommendations from previous versions. Colored markings in the algorithm show changes and the discussion aims to further the understanding of these changes by summarizing salient portions of the NCCN Guideline Panel discussion, including the literature reviewed. These NCCN Guidelines Insights do not represent the full NCCN Guidelines; further, the National Comprehensive Cancer Network ® (NCCN ®) makes no representation or warranties of any kind regarding the content, use, or application of the NCCN Guidelines and NCCN Guidelines Insights and disclaims any responsibility for their applications or use in any way. The full and most current version of these NCCN Guidelines are available at NCCN.org.
Prostate Cancer, Version 2.2019, NCCN Clinical Practice Guidelines in Oncology
Journal of the National Comprehensive Cancer Network, 2019
The NCCN Guidelines for Prostate Cancer include recommendations regarding diagnosis, risk stratification and workup, treatment options for localized disease, and management of recurrent and advanced disease for clinicians who treat patients with prostate cancer. The portions of the guidelines included herein focus on the roles of germline and somatic genetic testing, risk stratification with nomograms and tumor multigene molecular testing, androgen deprivation therapy, secondary hormonal therapy, chemotherapy, and immunotherapy in patients with prostate cancer.
National Comprehensive Cancer Network guidelines for the management of prostate cancer
Urology, 2003
Guidelines for the management of prostate cancer issued by the National Comprehensive Cancer Network provide a basis for rational treatment decisions. These guidelines represent consensus recommendations by a panel of experts that are evidence based and are designated according to the degree of consensus within the expert panel. The initial stratification point is the patient's life expectancy (Ͼ5 or Ͻ5 years). If life expectancy is Ͼ5 years, the recommended intervention is based on clinical stage, prostate-specific antigen (PSA) level, and Gleason score, as well as the presence of symptoms. These assessments establish the patient's risk of recurrence after therapy. Specific initial therapies are then recommended according to whether the risk category is low, intermediate, high, or very high. The guidelines also describe the appropriate use of observation ("watchful waiting") versus active intervention in certain patients. After definitive therapy, patients should be monitored with PSA determinations, digital rectal examination, and bone scans, as outlined in the guidelines. Patients who exhibit increasing PSA levels after prostatectomy are candidates for salvage therapy with androgen ablation, radiotherapy, or observation. If PSA levels begin to increase after radiotherapy, surgery may then be an additional option. Systemic salvage therapy generally consists of androgen ablation; the benefit of total androgen blockade versus initial monotherapy remains controversial. Relapse after initial androgen ablation is treated with an antiandrogen, if none had been administered previously. Patients refractory to further hormonal manipulations are observed or receive palliative therapy, including chemotherapy. The treatment of prostate cancer is complex. Optimal treatment is risk-adapted to the specific characteristics of the cancer and the expected longevity and personal preferences of the patient.
Canadian consensus forum of key controversial areas in the management of advanced prostate cancer
Canadian Urological Association Journal, 2021
Introduction: Rapid progress in diagnostics and therapeutics for the management of prostate cancer (PCa) have created areas where high-level evidence to guide practice is lacking. The Genitourinary Research Consortium (GURC) conducted its second Canadian consensus forum to address areas of controversy in the management of PCa and provide recommendations to guide treatment. Methods: A panel of PCa specialists discussed topics related to the management of PCa. The core scientific committee finalized the design, questions and the analysis of the consensus results. Attendees then voted to indicate their management choice regarding each statement/topic. Questions for voting were adapted from the 2019 Advanced Prostate Cancer Consensus Conference. The thresholds for agreement were set at ≥ 75% for ‘consensus agreement’, > 50% for “near-consensus”, and ≤ 50% for “no consensus”. Results: The panel was comprised of 29 PCa experts including urologists (n=12), medical oncologists (n= 12), a...
Annals of oncology : official journal of the European Society for Medical Oncology / ESMO, 2015
The first St.Gallen Advanced Prostate Cancer Consensus Conference (APCCC) Expert Panel identified and reviewed the available evidence for the ten most important areas of controversy in advanced prostate cancer management. The successful registration of several drugs for castration-resistant prostate cancer and the recent studies of chemo-hormonal therapy in men with castration-naïve prostate cancer have led to considerable uncertainty as to the best treatment choices, sequence of treatment options and appropriate patient selection.Management recommendations based on expert opinion, and not based on a critical review of the available evidence, are presented. The various recommendations carried differing degrees of support, as reflected in the wording of the article text and in the detailed voting results recorded in supplementary material, available at Annals of Oncology online. Detailed decisions on treatment as always will involve consideration of disease extent and location, prior...
World Journal of Urology, 2020
Purpose Advancements in the diagnosis and treatment of prostate cancer (PC) have rapidly progressed through the past years. Various factors should be taken into account while treating individual patients to ensure optimal and careful decision making. The purpose of this consensus review is to summarize the current practice patterns when managing patients with advanced prostate cancer (APC) as there is still a lack of or very limited evidence on its clinical management in some areas. Methods Pre-defined questions were shared with experts prior to the consensus session that took place in Cairo, Egypt in April 2019 during the 8th International gastrointestinal, liver and uro-oncology conference (IGILUC). Voting was based mainly on the expert opinions of the panel after a thorough discussion and review of available evidence from guidelines or best evidence available concerning the topic at hand. Results A strong consensus or unanimity was reached on 47% of the proposed questions. Notably, the panelists reached consensus on several topics based on high-level expert opinion. These findings contribute in several ways to our understanding of the management of PC and provide a basis for future recommendations. There was also a lack of consensus on other several topics, which suggests the need for further supporting data addressing these knowledge gaps. Conclusion This review offers a thorough understanding of APC practice and offers insight on the various opinions shared amongst experts in the field that can serve as guidance regionally and deepens our understanding of disease management globally.
European Urology, 2020
Background: Innovations in treatments, imaging, and molecular characterisation in advanced prostate cancer have improved outcomes, but there are still many aspects of management that lack high-level evidence to inform clinical practice. The Advanced Prostate Cancer Consensus Conference (APCCC) 2019 addressed some of these topics to supplement guidelines that are based on level 1 evidence. Objective: To present the results from the APCCC 2019. Design, setting, and participants: Similar to prior conferences, experts identified 10 important areas of controversy regarding the management of advanced prostate cancer: locally advanced disease, biochemical recurrence after local therapy, treating the primary tumour in the metastatic setting, metastatic hormone-sensitive/naïve prostate cancer, nonmetastatic castration-resistant prostate cancer, metastatic castration-resistant prostate cancer, bone health and bone metastases, molecular characterisation of tissue and blood, inter-and intrapatient heterogeneity, and adverse effects of hormonal therapy and their management. A panel of 72 international prostate cancer experts developed the programme and the consensus questions. Outcome measurements and statistical analysis: The panel voted publicly but anonymously on 123 predefined questions, which were developed by both voting and nonvoting panel members prior to the conference following a modified Delphi process. Results and limitations: Panellists voted based on their opinions rather than a standard literature review or formal meta-analysis. The answer options for the consensus questions had varying degrees of support by the panel, as reflected in this article and the detailed voting results reported in the Supplementary material. Conclusions: These voting results from a panel of prostate cancer experts can help clinicians and patients navigate controversial areas of advanced prostate management for which high-level evidence is sparse. However, diagnostic and treatment decisions should always be individualised based on patient-specific factors, such as disease extent and location, prior lines of therapy, comorbidities, and treatment preferences, together with current and emerging clinical evidence and logistic and economic constraints. Clinical trial enrolment for men with advanced prostate cancer should be strongly encouraged. Importantly, APCCC 2019 once again identified important questions that merit assessment in specifically designed trials. Patient summary: The Advanced Prostate Cancer Consensus Conference provides a forum to discuss and debate current diagnostic and treatment options for patients with advanced prostate cancer. The conference, which has been held three times since 2015, aims to share the knowledge of world experts in prostate cancer management with
European urology, 2017
In advanced prostate cancer (APC), successful drug development as well as advances in imaging and molecular characterisation have resulted in multiple areas where there is lack of evidence or low level of evidence. The Advanced Prostate Cancer Consensus Conference (APCCC) 2017 addressed some of these topics. To present the report of APCCC 2017. Ten important areas of controversy in APC management were identified: high-risk localised and locally advanced prostate cancer; "oligometastatic" prostate cancer; castration-naïve and castration-resistant prostate cancer; the role of imaging in APC; osteoclast-targeted therapy; molecular characterisation of blood and tissue; genetic counselling/testing; side effects of systemic treatment(s); global access to prostate cancer drugs. A panel of 60 international prostate cancer experts developed the program and the consensus questions. The panel voted publicly but anonymously on 150 predefined questions, which have been developed follow...
Journal of Urology, 2008
Purpose: Increasingly there is a recognized need for the development of high quality, evidenced-based clinical guidelines to assist clinicians and patients in critically important treatment related decision making. We review the different approaches used by leading urological organizations to develop guidelines for the management of clinically localized prostate cancer and their specific recommendations for case management. Materials and Methods: Guidelines for the management of localized prostate cancer developed by leading professional organizations were identified through the National Guidelines Clearinghouse™, PubMed®, cited references and personal communication with prostate cancer experts. A structured data abstraction was applied to assess how the guideline was developed, what type of professionals and stakeholders were involved in the development process, how the primary evidence was identified and graded, and what specific final recommendations were reported. Results: Clinical practice guidelines on the management of clinically localized prostate cancer demonstrate major differences in their specific recommendations. Few recommendations are based on high level evidence, and there are considerable discrepancies among the systems used to grade the quality of the evidence and the strength of the recommendations. Conclusions: There appears to be a need to standardize the process used by leading urological organizations to develop clinical guidelines for the management of prostate cancer. A unified approach may offer considerable rewards in terms of efficiency, guideline credibility and optimal clinical decision making. Furthermore, increased efforts are indicated to promote studies that yield high quality evidence to guide the management of prostate cancer.