eUpdate – Prostate Cancer Algorithms

eUpdate – Prostate Cancer Algorithms

Published: 22 September 2016. Authors:C. Parker1, S. Gillessen2 & A. Horwich3 on behalf of the ESMO Guidelines Committee

1Royal Marsden Hospital, Sutton, UK; 2Department of Oncology/Hematology, Kantonsspital St Gallen, St Gallen, Switzerland; 3The Institute of Cancer Research, London, UK

Note: Other eUpdates may have been published for these guidelines. All currently valid eUpdates can be accessed from the page displaying the full guidelines on this topic

Clinical Practice Guidelines

This update refers to the  Cancer of the prostate: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up, Parker C, Gillessen S, Heidenreich A and Horwich A, Ann Oncol 2015; 26 (Suppl63): v69-v77.

Diagnostic work-up and staging

Genitourinary Cancers Treatment Algorithms Diagnostic Work-up and Staging

aIn addition to PSA level, the decision to biopsy should be made in light of DRE findings, ethnicity, age, comorbidities, free/total PSA, history of previous biopsy and patient values; bindications for a repeat biopsy after a negative biopsy include a rising PSA, suspicious DRE, abnormal multi-parametric MRI, atypical acinar proliferation, multifocal high-grade prostatic intraepithelial neoplasia; cbefore repeat biopsy, multi-parametric MRI is recommended with a view to MRI-guided or MRI-TRUS fusion biopsy. CT, computed tomography; DRE, digital rectal examination; GS, Gleason score; MRI, magnetic resonance imaging; PET, positron emission tomography; PSA, prostate-specific antigen; TRUS, trans-rectal ultrasound.

Localised disease treatment algorithm

Genitourinary Cancers Treatment Algorithms Treatment of Localised Disease

High-risk localised and locally advanced disease treatment algorithm

Genitourinary Cancers Treatment Algorithms High-risk Localised and Locally Advanced Disease

Metastatic disease treatment algorithm

Genitourinary Cancers Treatment Algorithms Metastatic Disease

aAlso suitable for localised/locally advanced disease if patient not suitable for (or unwilling to have) radical treatment; binform patients of pros and cons; cfor men with biochemical relapse and symptomatic local disease, proven metastases or a PSA doubling time of <3 months; donly use Radium-223 if no visceral metastases. ADT, androgen-deprivation therapy; ChT, chemotherapy; EBRT, external-beam radiotherapy; HT, hormonal therapy; PC, prostate cancer; PSA, prostate-specific antigen; RP, radical prostatectomy; RT, radiotherapy.