PLANS
Risk Stratification
This plan is formulated from AUA guidelines, Michigan Urologic Surgery Improvement Collective (MUSIC),
Very Low Risk
PSA <10 ng/ml AND Grade Group 1 AND clinical stage T1-T2a AND <34% of biopsy cores positive AND no core with >50% involved, AND PSA density <0.15 ng/ml/cc
Recommend no imaging and AS |
Active Surveillance
|
Low Risk
|
Intermediate Risk: Favorable
|
Intermediate Risk: Unfavorable
|
High Risk
PSA >20 ng/ml
Grade group 4 or 5 T3 Needs CT or MRI and bone scan Recommend RP or RT + ADT Watchful waiting only asymptomatic men with ≤5 yr life expectancy No primary ADT unless limited LE and symptoms Consider genetic referral if strong fam hx of breast, ovarian, pancreatic, other gastrointestinal tumors, lymphoma |
In low risk, surgical and radiation treatments do not improve survival at 10 years vs. AS, does reduce disease progression and development of metastatic disease shown in PIVOT (10% versus 5%) and PROTECT (6% versus 2%). AS for intermediate risk has higher rate of metastasis (2,3)
- AUA Gudielines.Viewed May 10, 2018. http://www.auanet.org/guidelines/clinically-localized-prostate-cancer-new-(aua/astro/suo-guideline-2017)
- 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; 375:1415. PROTECT TRIAL
- Wilt TJ, Brawer MK, Jones KM: Radical prostatectomy versus observation for localized prostate cancer. N Engl J Med 2012; 367:203. PIVOT TRIAL
- MUSIC