06/14/2017

NCCN has published updates to the NCCN Guidelines® for Prostate Cancer Early Detection

NCCN has published updates to the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines^®) for Prostate Cancer Early Detection. These NCCN Guidelines^® are currently available as Version 1.2017. 

• Baseline Evaluation (PROSD-2
  • Modified footnote “a” regarding “Race:” replaced “However, the effects of earlier or more intensive screening on cancer outcomes and on screening-related harms in African-American men remain unclear. Therefore, although these men may require a higher level of vigilance and different considerations when analyzing the results of screening tests, the panel cannot provide separate screening recommendations for these men until more data become available” with “This is attributable to a greater risk of developing preclinical prostate cancer and a higher likelihood that a preclinical tumor will spread. Consequently it is reasonable for African-American men to begin discussing PSA screening with their providers several years earlier than Caucasian-American men and to consider screening at annual intervals rather than every other year.”
  • Added a new footnote to “Family or personal history of BRCA1 / 2 mutations:” The footnote states “If there is a known or suspected cancer susceptibility gene, referral to a cancer-genetics professional is recommended. BRCA1/2 pathogenic mutation carriers are associated with an increased risk of prostate cancer before age 65 years, and prostate cancer in men with germline BRCA2 mutations occurs earlier and is more likely to be associated with prostate cancer mortality. Information regarding BRCA1/2 gene status should be used as part of the discussion about prostate cancer screening. See Discussion.”

• Risk Assessment (PROSD-2)
  • Modified last bullet: “Strongly consider baseline digital rectal examination (DRE).”

• Early Detection Evaluation (PROSD-2)
  • Age >75y, in select patients (category 2B): changed indications for biopsy from “PSA >3 ng/mL or very suspicious DRE” to “PSA ≥4 ng/mL or very suspicious DRE.”

• Indications for Biopsy and Management (PROSD-3)
  • Moved “Consider percent free PSA, 4Kscore, or PHI” to prior to TRUS-guided biopsy.
  • Added “Consider multiparametric MRI” prior to TRUS-guided biopsy.
  • Added a new footnote to “Follow up in 6-12 mo with PSA/DRE.” The footnote states “Patients with a persistent and significant increase in PSA should be encouraged to undergo TRUS-guided biopsy.”
  • Modified the following footnote: “Biomarkers that improve the specificity of detection are not, as yet, recommended as first-line screening tests. However, there may be some patients who meet PSA standards for consideration of prostate biopsy, but for whom the patient and/or the physician wish to further define the probability of high-grade cancer. A percent free PSA <10%, PHI >35 or 4Kscore (which provides an estimate of the probability of high-grade prostate cancer) are potentially informative in patients who have never undergone biopsy or after a negative biopsy; a PCA3 score >35 is potentially informative after a negative biopsy. The predictive value of the serum biomarkers discussed above has not been correlated with that of MRI. Therefore it is not known how such tests could be applied in optimal combination.”

• Management of Biopsy Results (PROSD-4)
  • Atypia, suspicious for cancer: revised follow-up recommendations to state:
    • Consider serum or urine tests and/or multiparametric MRI.
    • Consider repeated biopsy with relative increased sampling of the atypical site.

For the complete updated versions of the NCCN Guidelines, NCCN Guidelines with NCCN Evidence Blocks™, the NCCN Drugs & Biologics Compendium (NCCN Compendium^®), the NCCN Biomarkers Compendium^®, the NCCN Chemotherapy Order Templates (NCCN Templates^®), the NCCN Radiation Therapy Compendium™, and the NCCN Imaging Appropriate Use Criteria (NCCN Imaging AUC™), please visit NCCN.org.