09 January 2010

NCCN updates recommend the value of active surveillance

The updated NCCN clinical guidelines for prostate cancer now include an explicit recommendation for active surveillance (watchful waiting) and only active surveillance for many men diagnosed with prostate cancer.

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.

But 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. By consequence, 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.

    Active surveillance of prostate cancer 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.



    NOTE: Issues on this site regarding prostate cancer and treatment options, are provided for information only, and are not meant to substitute for the advice of your own physician or other medical professional. Prostate-Report.org does not endorse any specific product, service or treatment.





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