Along with the Prostate Cance Research Institute, many other PC organizations are starting to recommend As as the 1st line treatment for low risk PC.
From the "New" prostate Cancer InfoLink...
In a news release issued earlier today, the National Comprehensive Cancer Network (NCCN) has announced updates to the NCCN Clinical Practice Guidelines for Oncology™ for Prostate Cancer, and has placed a new emphasis on the value of active surveillance in management of men with low and very low risk of clinically significant disease.
The revised NCCN clinical guidelines
now include an explicit recommendation for active surveillance and only active surveillance for many men diagnosed with prostate cancer. In particular, they state that:
Men with low-risk prostate cancer who have a life expectancy of less than 10 years should be offered and recommended active surveillance.
A new “very low-risk” category has been added to the guidelines using a modification of the so-called “Epstein criteria” for clinically insignificant prostate cancer.
* Only active surveillance should be offered and recommended for men with very low-risk prostate cancer when life expectancy is less than 20 years.
This new guidance may be considered controversial by many in the patient and the physician community, given the lack of established outcome data from randomized clinical trials comparing active surveillance to immediate interventional therapy. However, The “New” Prostate Cancer InfoLink would emphasize that active surveillance is not “no treatment.”
Active surveillance is a “deferred treatment” strategy, whereby the patient and his doctor set out to give necessary treatment only if and when it is needed. The intent is to be able to offer curative therapy to patients who need curative therapy before the disease spreads but to avoid over-treatment of patients who are likely to have greater risk of harm than benefit from immediate curative treatment. And in the case of many patients this means that treatment may be deferred indefinitely or even forever.
According to James L. Mohler, MD, of Roswell Park Cancer Institute, who is the current chair of the NCCN Guidelines Panel for Prostate Cancer, “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. 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,” 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.”
It will be interesting to see how the urology and the radiation oncology communities react to these guidelines. Even though respected urologists and radiation oncologists are members of this guideline committee, that does not necessarily mean that the rest of the urology and radiation oncology community are going to rush to endorse this guidance. For the “New” Prostate Cancer InfoLink, we believe that the emphasis needs to be placed on the “thorough discussion” that needs to take place between the patient and his physicians.