What are the AUA/ASTRO/SUO treatment guidelines for low-risk prostate cancer?

Updated: Jul 31, 2017
  • Author: Bagi RP Jana, MD; more...
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Answer

Guidelines from the American Urological Association, the American Society for Radiation Oncology (ASTRO) and the Society of Urologic Oncology (SUO) for management of clinically localized prostate cancer include the following recommendations for very-low-risk and low-risk disease [7] :

  • Abdominal-pelvic CT or routine bone scans hsould not be performed as part of the staging of asymptomatic patients with very-low-risk or low-risk prostate cancer. (Strong Recommendation; Evidence Level: Grade C)
  • Clinicians should recommend active surveillance as the best available care option for patients with very-low-risk localized prostate cancer. (Strong Recommendation; Evidence Level: Grade A)
  • Clinicians should recommend active surveillance as the preferable care option for most patients with low-risk localized prostate cancer. (Moderate Recommendation; Evidence Level: Grade B)
  • Clinicians may offer definitive treatment (ie, radical prostatectomy or radiotherapy) to select low-risk localized prostate cancer patients who may have a high probability of progression on active surveillance. (Conditional Recommendation; Evidence Level: Grade B)
  • Clinicians should not add androgen deprivation therapy (ADT) to radiotherapy for low-risk localized prostate cancer, except to reduce the size of the prostate for brachytherapy. (Strong Recommendation; Evidence Level: Grade B)
  • Clinicians should inform low-risk prostate cancer patients considering whole gland cryosurgery that consequent side effects are considerable and survival benefit has not been shown in comparison with active surveillance. (Conditional Recommendation; Evidence Level: Grade C)
  • Clinicians should inform low-risk prostate cancer patients who are considering focal therapy or high-intensity focused ultrasound (HIFU) that these interventions are not standard care options because comparative outcome evidence is lacking. (Expert Opinion)
  • Clinicians should recommend observation or watchful waiting for men with a life expectancy ≤5 years with low-risk localized prostate cancer. (Strong Recommendation; Evidence Level: Grade B)
  • In most cases of low-risk localized prostate cancer, tissue-based genomic biomarkers have not shown a clear role in the selection of candidates for active surveillance. (Expert Opinion)

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