Prostate Cancer, Version 3.2024

Featured Updates to the NCCN Guidelines

Authors:
Edward M. Schaeffer Robert H. Lurie Comprehensive Cancer Center of Northwestern University

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Sandy Srinivas Stanford Cancer Institute

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Nabil Adra Indiana University Melvin and Bren Simon Comprehensive Cancer Center

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Yi An Yale Cancer Center/Smilow Cancer Hospital

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Rhonda Bitting Duke Cancer Institute

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Brian Chapin The University of Texas MD Anderson Cancer Center

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Heather H. Cheng Fred Hutchinson Cancer Center

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Anthony Victor D’Amico Dana-Farber/Brigham and Women's Cancer Center

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Neil Desai UT Southwestern Simmons Comprehensive Cancer Center

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Tanya Dorff City of Hope National Cancer Center

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James A. Eastham Memorial Sloan Kettering Cancer Center

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Thomas A. Farrington Prostate Health Education Network (PHEN)

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Xin Gao Mass General Cancer Center

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Shilpa Gupta Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute

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Thomas Guzzo Abramson Cancer Center at The University of Pennsylvania

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Joseph E. Ippolito Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine

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R. Jeffrey Karnes Mayo Clinic Comprehensive Cancer Center

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Michael R. Kuettel Roswell Park Comprehensive Cancer Center

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Joshua M. Lang University of Wisconsin Carbone Cancer Center

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Tamara Lotan The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins

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Rana R. McKay UC San Diego Moores Cancer Center

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Todd Morgan University of Michigan Rogel Cancer Center

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Julio M. Pow-Sang Moffitt Cancer Center

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Robert Reiter UCLA Jonsson Comprehensive Cancer Center

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Mack Roach III UCSF Helen Diller Family Comprehensive Cancer Center

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Tyler Robin University of Colorado Cancer Center

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Stan Rosenfeld University of California San Francisco Patient Services Committee

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Ahmad Shabsigh The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute

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Daniel Spratt Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute

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Russell Szmulewitz The UChicago Medicine Comprehensive Cancer Center

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Benjamin A. Teply Fred & Pamela Buffett Cancer Center

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Jonathan Tward Huntsman Cancer Institute at the University of Utah

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Richard Valicenti UC Davis Comprehensive Cancer Center

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Jessica Karen Wong Fox Chase Cancer Center

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Jenna Snedeker National Comprehensive Cancer Network

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Deborah A. Freedman-Cass National Comprehensive Cancer Network

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The NCCN Guidelines for Prostate Cancer include recommendations for staging and risk assessment after a prostate cancer diagnosis and for the care of patients with localized, regional, recurrent, and metastatic disease. These NCCN Guidelines Insights summarize the panel's discussions for the 2024 update to the guidelines with regard to initial risk stratification, initial management of very-low-risk disease, and the treatment of nonmetastatic recurrence.

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  • 1.

    Siegel RL, Giaquinto AN, Jemal A. Cancer statistics, 2024. CA Cancer J Clin 2024;74:1249.

  • 2.

    D’Amico AV, Whittington R, Malkowicz SB, et al. Biochemical outcome after radical prostatectomy or external beam radiation therapy for patients with clinically localized prostate carcinoma in the prostate specific antigen era. Cancer 2002;95:281286.

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  • 3.

    D’Amico AV, Whittington R, Malkowicz SB, et al. Biochemical outcome after radical prostatectomy, external beam radiation therapy, or interstitial radiation therapy for clinically localized prostate cancer. JAMA 1998;280:969974.

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  • 4.

    Tom MC, Reddy CA, Smile TD, et al. Validation of the NCCN prostate cancer favorable- and unfavorable-intermediate risk groups among men treated with I-125 low dose rate brachytherapy monotherapy. Brachytherapy 2020;19:4350.

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  • 5.

    Berlin A, Moraes FY, Sanmamed N, et al. International multicenter validation of an intermediate risk subclassification of prostate cancer managed with radical treatment without hormone therapy. J Urol 2019;201:284291.

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  • 6.

    Pompe RS, Karakiewicz PI, Tian Z, et al. Oncologic and functional outcomes after radical prostatectomy for high or very high risk prostate cancer: European validation of the current NCCN guideline. J Urol 2017;198:354361.

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  • 7.

    Xu H, Zhu Y, Dai B, et al. National Comprehensive Cancer Network (NCCN) risk classification in predicting biochemical recurrence after radical prostatectomy: a retrospective cohort study in Chinese prostate cancer patients. Asian J Androl 2018;20:551554.

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  • 8.

    Dess RT, Suresh K, Zelefsky MJ, et al. Development and validation of a clinical prognostic stage group system for nonmetastatic prostate cancer using disease-specific mortality results from the international staging collaboration for cancer of the prostate. JAMA Oncol 2020;6:19121920.

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  • 9.

    Zelic R, Garmo H, Zugna D, et al. Predicting prostate cancer death with different pretreatment risk stratification tools: a head-to-head comparison in a nationwide cohort study. Eur Urol 2020;77:180188.

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  • 10.

    Epstein JI, Amin MB, Fine SW, et al. The 2019 Genitourinary Pathology Society (GUPS) white paper on contemporary grading of prostate cancer. Arch Pathol Lab Med 2021;145:461493.

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  • 11.

    Ho MD, Ross AE, Eggener SE. Risk stratification of low-risk prostate cancer: individualizing care in the era of active surveillance. J Urol 2023;210:3845.

  • 12.

    Roberts MJ, Maurer T, Perera M, et al. Using PSMA imaging for prognostication in localized and advanced prostate cancer. Nat Rev Urol 2023;20:2347.

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  • 14.

    Castro E, Goh C, Olmos D, et al. Germline BRCA mutations are associated with higher risk of nodal involvement, distant metastasis, and poor survival outcomes in prostate cancer. J Clin Oncol 2013;31:17481757.

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  • 15.

    Carter HB, Helfand B, Mamawala M, et al. Germline mutations in ATM and BRCA1/2 are associated with grade reclassification in men on active surveillance for prostate cancer. Eur Urol 2019;75:743749.

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  • 16.

    Millikan R, Logothetis C. Update of the NCCN guidelines for treatment of prostate cancer. Oncology (Williston Park) 1997;11:180193.

  • 17.

    Logothetis C, Millikan R, Baker LH, et al. Update: NCCN Practice Guidelines for Treatment of Prostate Cancer. Oncology (Williston Park) 1999;13:118132.

  • 18.

    Bahnson RR, Hanks GE, Huben RP, et al. NCCN Practice Guidelines for Prostate Cancer. Oncology (Williston Park) 2000;14:111119.

  • 19.

    Epstein JI, Walsh PC, Carmichael M, et al. Pathologic and clinical findings to predict tumor extent of nonpalpable (stage T1c) prostate cancer. JAMA 1994;271:368374.

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  • 20.

    Shee K, Cowan JE, Balakrishnan A, et al. Limited relevance of the very low risk prostate cancer classification in the modern era: results from a large institutional active surveillance cohort. Eur Urol 2023;84:912.

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  • 21.

    Eastham JA, Auffenberg GB, Barocas DA, et al. Clinically localized prostate cancer: AUA/ASTRO guideline, part I: introduction, risk assessment, staging, and risk-based management. J Urol 2022;208:1018.

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  • 22.

    Simon RM, Paik S, Hayes DF. Use of archived specimens in evaluation of prognostic and predictive biomarkers. J Natl Cancer Inst 2009;101:14461452.

  • 23.

    Vince RA Jr, Jiang R, Qi J, et al. Impact of Decipher Biopsy testing on clinical outcomes in localized prostate cancer in a prospective statewide collaborative. Prostate Cancer Prostatic Dis 2022;25:677683.

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  • 24.

    Spratt DE, Lio VY, Michalski J, et al. Genomic classifier performance in intermediate-risk prostate cancer: results from NRG Oncology/RTOG 0126 randomized phase III trial. Int J Radiat Oncol Biol Phys 2023;117:370377.

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  • 25.

    Nguyen PL, Huang HR, Spratt DE, et al. Analysis of a biopsy-based genomic classifier in high-risk prostate cancer: meta-analysis of the NRG Oncology/Radiation Therapy Oncology Group 9202, 9413, and 9902 phase 3 randomized trials. Int J Radiat Oncol Biol Phys 2023;116:521529.

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  • 26.

    Attard G, Parry M, Grist E, et al. Clinical testing of transcriptome-wide expression profiles in high-risk localized and metastatic prostate cancer starting androgen deprivation therapy: an ancillary study of the STAMPEDE abiraterone phase 3 trial. Res Sq. Preprint posted online February 8, 2023. doi:10.21203/rs.3.rs-2488586/v1

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  • 27.

    Feng FY, Huang HC, Spratt DE, et al. Validation of a 22-gene genomic classifier in patients with recurrent prostate cancer: an ancillary study of the NRG/RTOG 9601 randomized clinical trial. JAMA Oncol 2021;7:544552.

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  • 28.

    Dal Pra A, Ghadjar P, Hayoz S, et al. Validation of the Decipher genomic classifier in patients receiving salvage radiotherapy without hormone therapy after radical prostatectomy—an ancillary study of the SAKK 09/10 randomized clinical trial. Ann Oncol 2022;33:950958.

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  • 29.

    Cooperberg MR, Simko JP, Cowan JE, et al. Validation of a cell-cycle progression gene panel to improve risk stratification in a contemporary prostatectomy cohort. J Clin Oncol 2013;31:14281434.

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  • 30.

    Cuzick J, Swanson GP, Fisher G, et al. Prognostic value of an RNA expression signature derived from cell cycle proliferation genes in patients with prostate cancer: a retrospective study. Lancet Oncol 2011;12:245255.

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  • 31.

    Canter DJ, Reid J, Latsis M, et al. Comparison of the prognostic utility of the cell cycle progression score for predicting clinical outcomes in African American and non-African American men with localized prostate cancer. Eur Urol 2019;75:515522.

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  • 32.

    Klein EA, Cooperberg MR, Magi-Galluzzi C, et al. A 17-gene assay to predict prostate cancer aggressiveness in the context of Gleason grade heterogeneity, tumor multifocality, and biopsy undersampling. Eur Urol 2014;66:550560.

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  • 33.

    Esteva A, Feng J, van der Wal D, et al. Prostate cancer therapy personalization via multi-modal deep learning on randomized phase III clinical trials. NPJ Digit Med 2022;5:71.

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  • 34.

    Spratt DE, Tang S, Sun Y, et al. Artificial intelligence predictive model for hormone therapy use in prostate cancer. NEJM Evid 2023;2:EVIDoa2300023.

  • 35.

    Hamdy FC, Donovan JL, Lane JA, et al. Fifteen-year outcomes after monitoring, surgery, or radiotherapy for prostate cancer. N Engl J Med 2023;388:15471558.

  • 36.

    Hamdy FC, Donovan JL, Lane JA, et al. 10-year outcomes after monitoring, surgery, or radiotherapy for localized prostate cancer. N Engl J Med 2016;375:14151424.

  • 37.

    Donovan JL, Hamdy FC, Lane JA, et al. Patient-reported outcomes after monitoring, surgery, or radiotherapy for prostate cancer. N Engl J Med 2016;375:14251437.

  • 38.

    Neal DE, Metcalfe C, Donovan JL, et al. Ten-year mortality, disease progression, and treatment-related side effects in men with localised prostate cancer from the ProtecT randomised controlled trial according to treatment received. Eur Urol 2020;77:320330.

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  • 39.

    Freedland SJ, de Almeida Luz M, De Giorgi U, et al. Improved outcomes with enzalutamide in biochemically recurrent prostate cancer. N Engl J Med 2023;389:14531465.

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