NCCN Tightens the reigns on Active Surveillance...

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Tony Crispino
Veteran Member

Date Joined Dec 2006
Total Posts : 8128
   Posted 5/16/2011 5:36 PM (GMT -6)   
This was a bit of a surprise to me as I expected the National Comprehensive Cancer Network to LOOSEN these reigns. Since I can't link this article here is the text:

NCCN Tightens Active Surveillance in Prostate Cancer Guidelines
Elsevier Global Medical News. 2011 Apr 6, D Mahoney

HOLLYWOOD, FLA. (EGMN) - Updated prostate cancer guidelines from the National Comprehensive Cancer Network call for more stringent monitoring of low-risk and very-low-risk patients who have opted for active surveillance.

The more rigorous protocol should help allay patient anxiety about "watchful waiting," while minimizing the likelihood of overtreatment and its associated risks and side affects, Dr. James L. Mohler explained at the NCCN annual conference.

Based primarily on expert consensus rather than new evidence from clinical trials, the recommendations include the following:

• Prostate-specific antigen (PSA) testing at least every 6 months and as often as every 3 months.

• Digital rectal examination (DRE) at least every 12 months and as often as every 6 months.

• Repeat needle biopsy within 18 months for patients in whom the initial biopsy was 10 or more cores.

• Repeat initial biopsy within 6 months for patients in whom the initial biopsy was fewer than 10 cores.

• Consideration of a repeat biopsy for all patients as often as 12 months.

Previously, the NCCN had called for PSA testing and DREs as frequently as every 6 and 12 months, respectively, and deemed repeat needle biopsies to be optional within 6-18 months, depending on the number of cores initially biopsied, said Dr. Mohler.

Although the revised recommendations are more specific, they are still limited by the lack of quality evidence to support them, he said, noting that the first-ever North American phase III trial to compare active surveillance with mainstay prostate cancer treatments - the ongoing START (Surveillance Therapy Against Radical Treatment) study - is having trouble meeting enrollment goals because patients perceive active surveillance as "doing nothing."

In 2010, the NCCN prostate cancer guidelines recommended active surveillance as the only option for men with low-risk prostate cancer who had an estimated life expectancy less than 10 years and for men with very-low-risk prostate cancer (a newly defined patient subset) with a life expectancy less than 20 years, said Dr. Mohler, chair of the department of urology at Roswell Park Cancer Institute in Buffalo, N.Y.

Patients in the low-risk category are those with a stage T1-T2a tumor, a Gleason score of 2-6, and a PSA level less than 10 ng/mL, whereas very-low-risk patients are those with a stage T1a tumor, a Gleason score of 6 or less, a PSA level less than 10 ng/mL, fewer than three positive biopsy cores with no more than 50% cancer in each, and a PSA density below 0.15 ng/mL per gram, he explained.


Advanced Prostate Cancer at age 44 (I am 48 now)
pT3b,N0,Mx (original PSA was 19.8) EPE, PM, SVI. Gleason 4+3=7

Da Vinci Surgery ~ 2/16/2007
Adjuvant Radiation Therapy ~ IMRT Completed 8/07
Adjuvant Hormone Therapy ~ 28 months on Casodex and Lupron.
Undetectable PSA.

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