These guidelines are a statement of consensus of the authors regarding their views of currently accepted approaches to treatment. Any clinician seeking to apply or consult these guidelines is expected to use independent medical judgment in the context of individual clinical circumstances to determine any patient's care or treatment. The National Comprehensive Cancer Network makes no representation or warranties of any kind regarding their content, use, or application and disclaims any responsibility for their applications or use in any way.
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At the beginning of each NCCN guidelines panel meeting, panel members disclosed any financial support they have received from industry. Through 2008, this information was published in an aggregate statement in JNCCN and online. Furthering NCCN's commitment to public transparency, this disclosure process has now been expanded by listing all potential conflicts of interest respective to each individual expert panel member.
Individual disclosures for the NCCN Prostate Cancer Early Detection Guidelines Panel members can be found on page 262. (To view the most recent version of these guidelines and accompanying disclosures, visit the NCCN Web site at NCCN.org.)
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Ries LAG, Melbert D, Krapcho M et al.., eds. SEER Cancer Statistics Review, 1975–2004. National Cancer Institute. Bethesda, MD, 2007. Available at: http://seer.cancer.gov/csr/1975_2004/. Accessed December 21, 2009.
Carter BS, Beaty TH, Steinberg GD et al.. Mendelian inheritance of familial prostate cancer. Proc Natl Acad Sci U S A 1992;89:3367–3371.
Mondo DM, Roehl KA, Loeb S et al.. Which is the most important risk factor for prostate cancer: race, family history, or baseline PSA level? [absract]. J Urol 2008;179(Suppl):Abstract 417.
Klein EA, Kupelian PA, Witte JS. Does a family history of prostate cancer result in more aggressive disease? Prostate Cancer Prostatic Dis 1998;1:297–300.
Clegg LX, Li FP, Hankey BF et al.. Cancer survival among US whites and minorities: a SEER (Surveillance, Epidemiology, and End Results) Program population-based study. Arch Intern Med 2002;162:1985–1993.
Paquette EL, Sun L, Paquette LR et al.. Improved prostate cancer-specific survival and other disease parameters: impact of prostate-specific antigen testing. Urology 2002;60:756–759.
Harris R, Lohr KN. Screening for prostate cancer: an update of the evidence for the U.S. Preventive Services Task Force. Ann Intern Med 2002;137:917–929.
Catalona WJ, Richie JP, Ahmann FR et al.. Comparison of digital rectal examination and serum prostate specific antigen in the early detection of prostate cancer: results of a multicenter clinical trial of 6,630 men. J Urol 1994;151:1283–1290.
Catalona WJ, Smith DS, Ratliff TL, Basler JW. Detection of organ-confined prostate cancer is increased through prostate-specific antigen-based screening. JAMA 1993;270:948–954.
Andriole GL, Crawford ED, Grubb RL III et al.. Mortality results from a randomized prostate-cancer screening trial. N Engl J Med 2009;360:1310–1319.
Schroder FH, Hugosson J, Roobol MJ et al.. Screening and prostate-cancer mortality in a randomized European study. N Engl J Med 2009;360:1320–1328.
Brawer MK, Lin DW, Williford WO et al.. Effect of finasteride and/or terazosin on serum PSA: results of VA Cooperative Study #359. Prostate 1999;39:234–239.
Barqawi A, Gamito E, O'Donnell C, Crawford ED. Herbal and vitamin supplement use in a prostate cancer screening population. Urology 2004;63:288–292.
Gann PH, Hennekens CH, Stampfer MJ. A prospective evaluation of plasma prostate-specific antigen for detection of prostatic cancer. JAMA 1995;273:289–294.
Richie JP, Catalona WJ, Ahmann FR et al.. Effect of patient age on early detection of prostate cancer with serum prostate-specific antigen and digital rectal examination. Urology 1993;42:365–374.
Carter HB, Pearson JD, Metter EJ et al.. Longitudinal evaluation of prostate-specific antigen levels in men with and without prostate disease. JAMA 1992;267:2215–2220.
Carter HB, Ferrucci L, Kettermann A et al.. Detection of life-threatening prostate cancer with prostate-specific antigen velocity during a window of curability. J Natl Cancer Inst 2006;98:1521–1527.
Carter HB, Kettermann A, Ferrucci L et al.. Prostate-specific antigen velocity risk count assessment: a new concept for detection of life-threatening prostate cancer during window of curability. Urology 2007;70:685–690.
D'Amico AV, Chen MH, Roehl KA, Catalona WJ. Preoperative PSA velocity and the risk of death from prostate cancer after radical prostatectomy. N Engl J Med 2004;351:125–135.
Wolters T, Roobol MJ, Bangma CH, Schroder FH. Is prostate-specific antigen velocity selective for clinically significant prostate cancer in screening? European Randomized Study of Screening for Prostate Cancer (Rotterdam). Eur Urol 2008;55:385–392.
Thompson IM, Ankerst DP, Chi C et al.. Assessing prostate cancer risk: results from the Prostate Cancer Prevention Trial. J Natl Cancer Inst 2006;98:529–534.
Eggener SE, Roehl KA, Catalona WJ. Prostatitis confounds the use of PSA velocity for prostate cancer detection [abstract]. Presented at the 2006 ASCO Prostate Cancer Symposium; February 24–26, 2006; San Francisco, California.
Kobayashi M, Nukui A, Morita T. Serum PSA and percent free PSA value changes after antibiotic treatment. A diagnostic method in prostate cancer suspects with asymptomatic prostatitis. Urol Int 2008;80:186–192.
Oesterling JE, Jacobsen SJ, Chute CG et al.. Serum prostate-specific antigen in a community-based population of healthy men. Establishment of age-specific reference ranges. JAMA 1993;270:860–864.
Morgan TO, Jacobsen SJ, McCarthy WF et al.. Age-specific reference ranges for prostate-specific antigen in black men. N Engl J Med 1996;335:304–310.
Oesterling JE, Jacobsen SJ, Klee GG et al.. Free, complexed and total serum prostate specific antigen: the establishment of appropriate reference ranges for their concentrations and ratios. J Urol 1995;154:1090–1095.
Partin AW, Brawer MK, Subong EN et al.. Prospective evaluation of percent free-PSA and complexed-PSA for early detection of prostate cancer. Prostate Cancer Prostatic Dis 1998;1:197–203.
Partin AW, Brawer MK, Bartsch G et al.. Complexed prostate specific antigen improves specificity for prostate cancer detection: results of a prospective multicenter clinical trial. J Urol 2003;170:1787–1791.
Okihara K, Cheli CD, Partin AW et al.. Comparative analysis of complexed prostate specific antigen, free prostate specific antigen and their ratio in detecting prostate cancer. J Urol 2002;167:2017–2023; discussion 2023–2014.
Horninger W, Cheli CD, Babaian RJ et al.. Complexed prostate-specific antigen for early detection of prostate cancer in men with serum prostate-specific antigen levels of 2 to 4 nanograms per milliliter. Urology 2002;60:31–35.
Okihara K, Fritsche HA, Ayala A et al.. Can complexed prostate specific antigen and prostatic volume enhance prostate cancer detection in men with total prostate specific antigen between 2.5 and 4.0 ng./ml. J Urol 2001;165(6 Pt 1):1930–1936.
Babaian RJ, Naya Y, Cheli C, Fritsche HA. The detection and potential economic value of complexed prostate specific antigen as a first line test. J Urol 2006;175:897–901; discussion 901.
Benson MC, Whang IS, Pantuck A et al.. Prostate specific antigen density: a means of distinguishing benign prostatic hypertrophy and prostate cancer. J Urol 1992;147:815–816.
Lujan M, Paez A, Llanes L et al.. Prostate specific antigen density. Is there a role for this parameter when screening for prostate cancer? Prostate Cancer Prostatic Dis 2001;4:146–149.
Sozen S, Eskicorapci S, Kupeli B et al.. Complexed prostate specific antigen density is better than the other PSA derivatives for detection of prostate cancer in men with total PSA between 2.5 and 20 ng/ml: results of a prospective multicenter study. Eur Urol 2005;47:302–307.
- Search Google Scholar
- Export Citation
. Sozen S Eskicorapci S Kupeli B Complexed prostate specific antigen density is better than the other PSA derivatives for detection of prostate cancer in men with total PSA between 2.5 and 20 ng/ml: results of a prospective multicenter study. Eur Urol 2005; 47: 302– 307.
Veneziano S, Pavlica P, Compagnone G, Martorana G. Usefulness of the (F/T)/PSA density ratio to detect prostate cancer. Urol Int 2005;74:13–18.
Aksoy Y, Oral A, Aksoy H et al.. PSA density and PSA transition zone density in the diagnosis of prostate cancer in PSA gray zone cases. Ann Clin Lab Sci 2003;33:320–323.
Catalona WJ, Southwick PC, Slawin KM et al.. Comparison of percent free PSA, PSA density, and age-specific PSA cutoffs for prostate cancer detection and staging. Urology 2000;56:255–260.
Allan RW, Sanderson H, Epstein JI. Correlation of minute (0.5 MM or less) focus of prostate adenocarcinoma on needle biopsy with radical prostatectomy specimen: role of prostate specific antigen density. J Urol 2003;170:370–372.
Radwan MH, Yan Y, Luly JR et al.. Prostate-specific antigen density predicts adverse pathology and increased risk of biochemical failure. Urology 2007;69:1121–1127.
Fang J, Metter EJ, Landis P et al.. Low levels of prostate-specific antigen predict long-term risk of prostate cancer: results from the Baltimore Longitudinal Study of Aging. Urology 2001;58:411–416.
Loeb S, Roehl KA, Antenor JA et al.. Baseline prostate-specific antigen compared with median prostate-specific antigen for age group as predictor of prostate cancer risk in men younger than 60 years old. Urology 2006;67:316–320.
Catalona WJ, Smith DS, Ornstein DK. Prostate cancer detection in men with serum PSA concentrations of 2.6 to 4.0 ng/mL and benign prostate examination. Enhancement of specificity with free PSA measurements. JAMA 1997;277:1452–1455.
Babaian RJ, Johnston DA, Naccarato W et al.. The incidence of prostate cancer in a screening population with a serum prostate specific antigen between 2.5 and 4.0 ng/ml: relation to biopsy strategy. J Urol 2001;165:757–760.
Horninger W, Berger AP, Rogatsch H et al.. Characteristics of prostate cancers detected at low PSA levels. Prostate 2004;58:232–237.
Krumholtz JS, Carvalhal GF, Ramos CG et al.. Prostate-specific antigen cutoff of 2.6 ng/mL for prostate cancer screening is associated with favorable pathologic tumor features. Urology 2002;60:469–473; discussion 473–464.
Punglia RS, D'Amico AV, Catalona WJ et al.. Effect of verification bias on screening for prostate cancer by measurement of prostate-specific antigen. N Engl J Med 2003;349:335–342.
Thompson IM, Pauler DK, Goodman PJ et al.. Prevalence of prostate cancer among men with a prostate-specific antigen level < or =4.0 ng per milliliter. N Engl J Med 2004;350:2239–2246.
Lilja H, Ulmert D, Bjork T et al.. Long-term prediction of prostate cancer up to 25 years before diagnosis of prostate cancer using prostate kallikreins measured at age 44 to 50 years. J Clin Oncol 2007;25:431–436.
Schaeffer EM, Carter HB, Kettermann A et al.. Prostate specific antigen testing among the elderly—when to stop? J Urol 2009;181:1606–1614; discussion 1613–1604.
Presti JC Jr, O'Dowd GJ, Miller MC et al.. Extended peripheral zone biopsy schemes increase cancer detection rates and minimize variance in prostate specific antigen and age related cancer rates: results of a community multi-practice study. J Urol 2003;169:125–129.
- Search Google Scholar
- Export Citation
. Presti JC Jr O'Dowd GJ Miller MC Extended peripheral zone biopsy schemes increase cancer detection rates and minimize variance in prostate specific antigen and age related cancer rates: results of a community multi-practice study. J Urol 2003; 169: 125– 129.
Babaian RJ, Toi A, Kamoi K et al.. A comparative analysis of sextant and an extended 11-core multisite directed biopsy strategy. J Urol 2000;163:152–157.
Presti JC Jr, Chang JJ, Bhargava V, Shinohara K. The optimal systematic prostate biopsy scheme should include 8 rather than 6 biopsies: results of a prospective clinical trial. J Urol 2000;163:163–166; discussion 166–167.
Hong YM, Lai FC, Chon CH et al.. Impact of prior biopsy scheme on pathologic features of cancers detected on repeat biopsies. Urol Oncol 2004;22:7–10.
Meng MV, Franks JH, Presti JC Jr, Shinohara K. The utility of apical anterior horn biopsies in prostate cancer detection. Urol Oncol 2003;21:361–365.
Stewart CS, Leibovich BC, Weaver AL, Lieber MM. Prostate cancer diagnosis using a saturation needle biopsy technique after previous negative sextant biopsies. J Urol 2001;166:86–91; discussion 91–82.
Collins GN, Lloyd SN, Hehir M, McKelvie GB. Multiple transrectal ultrasound-guided prostatic biopsies—true morbidity and patient acceptance. Br J Urol 1993;71:460–463.
Stirling BN, Shockley KF, Carothers GG, Maatman TJ. Comparison of local anesthesia techniques during transrectal ultrasound-guided biopsies. Urology 2002;60:89–92.
Leibovici D, Zisman A, Siegel YI et al.. Local anesthesia for prostate biopsy by periprostatic lidocaine injection: a double-blind placebo controlled study. J Urol 2002;167:563–565.
Catalona WJ, Partin AW, Slawin KM et al.. Use of the percentage of free prostate-specific antigen to enhance differentiation of prostate cancer from benign prostatic disease: a prospective multicenter clinical trial. JAMA 1998;279:1542–1547.
Loeb S, Roehl KA, Catalona WJ. Is PSA velocity useful for prostate cancer detection or prognostication in men with a PSA > 10 ng/mL [abstract]? Presented at the American Urological Assocation Annual Meeting; April 25–30, 2009; Chicago, Illinois. Abstract 2239.
- Search Google Scholar
- Export Citation
. Is PSA velocity useful for prostate cancer detection or prognostication in men with a PSA > 10 ng/mL [abstract]? Loeb S Roehl KA Catalona WJ Presented at the American Urological Assocation Annual Meeting; April 25–30, 2009; Chicago, Illinois. Abstract 2239.
Iczkowski KA. Current prostate biopsy interpretation: criteria for cancer, atypical small acinar proliferation, high-grade prostatic intraepithelial neoplasia, and use of immunostains. Arch Pathol Lab Med 2006;130:835–843.
Ploussard G, Plennevaux G, Allory Y et al.. High-grade prostatic intraepithelial neoplasia and atypical small acinar proliferation on initial 21-core extended biopsy scheme: incidence and implications for patient care and surveillance. World J Urol 2009;27:587–592.
- Search Google Scholar
- Export Citation
. Ploussard G Plennevaux G Allory Y High-grade prostatic intraepithelial neoplasia and atypical small acinar proliferation on initial 21-core extended biopsy scheme: incidence and implications for patient care and surveillance. World J Urol 2009; 27: 587– 592.
Kumar-Sinha C, Shah RB, Laxman B et al.. Elevated alpha-methylacyl-CoA racemase enzymatic activity in prostate cancer. Am J Pathol 2004;164:787–793.
Shah RB, Kunju LP, Shen R et al.. Usefulness of basal cell cocktail (34betaE12 + p63) in the diagnosis of atypical prostate glandular proliferations. Am J Clin Pathol 2004;122:517–523.
Herawi M, Kahane H, Cavallo C, Epstein JI. Risk of prostate cancer on first re-biopsy within 1 year following a diagnosis of high grade prostatic intraepithelial neoplasia is related to the number of cores sampled. J Urol 2006;175:121–124.
O'Dowd G J, Miller MC, Orozco R, Veltri RW. Analysis of repeated biopsy results within 1 year after a noncancer diagnosis. Urology 2000;55:553–559.
Mian BM, Naya Y, Okihara K et al.. Predictors of cancer in repeat extended multisite prostate biopsy in men with previous negative extended multisite biopsy. Urology 2002;60:836–840.
Lefkowitz GK, Taneja SS, Brown J et al.. Followup interval prostate biopsy 3 years after diagnosis of high grade prostatic intraepithelial neoplasia is associated with high likelihood of prostate cancer, independent of change in prostate specific antigen levels. J Urol 2002;168:1415–1418.
- Search Google Scholar
- Export Citation
. Lefkowitz GK Taneja SS Brown J Followup interval prostate biopsy 3 years after diagnosis of high grade prostatic intraepithelial neoplasia is associated with high likelihood of prostate cancer, independent of change in prostate specific antigen levels. J Urol 2002; 168: 1415– 1418.