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
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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
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
High-risk localised and locally advanced disease treatment algorithm
Metastatic disease treatment algorithm
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.