NCCN Prostate 2.2020 Flashcards Preview

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Flashcards in NCCN Prostate 2.2020 Deck (51)
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1

A strong family history of prostate cancer consists of:

Brother or father or multiple family members diagnosed with prostate CA (NOT Grade Group I) at LESS THAN 60 YRS OLD OR who DIED from prostate CA


PROS-B

2

Family history criteria to prompt genetic testing:

1. Strong family history
2. Ashkenazi Jewish ancestry
3. >= 3 cancers on same side of family, esp. diagnoses <= 50 yrs of age

3

Clinical/Pathologic Features:

Very low risk

ALL of the ff:

T1c AND
Grade Group 1 AND
PSA < 10ng/mL
< 3 prostate biopsy fragments/cores positive, <= 50% cancer in each fragment/core AND
PSA Density < 0.15 ng/mL/g


PROS-2

4

Clinical/Pathologic Features:

Low risk

ALL of the ff but does not qualify for low risk:

T1-T2a AND
Grade Group 1 AND
PSA < 10 ng/mL


PROS-2

5

Clinical/Pathologic Features:

Favorable intermediate

1 IRF and
Grade Group 1 or 2 and
< 50% biopsy cores positive


PROS-2

6

Clinical/Pathologic Features:

Unfavorable intermediate

2 or 3 IRFs and/or
Grade Group 3 and/or
>= 50% biopsy cores positive


PROS-2

7

Clinical/Pathologic Features:

High risk

T3a OR
Grade Group 4 or Grade Group 5 or PSA > 20ng/mL


PROS-2

8

Clinical/Pathologic Features:

Very high risk

T3b-T4 OR
Primary Gleason pattern 5 OR
>4 cores with Grade Group 4 or 5


PROS-2

9

Active surveillance definition

Actively monitoring the course of disease with the expectation to intervene with potentially curative therapy if the cancer progresses.

10

Active surveillance components

mpMRI and/or prostate biopsy to confirm candidacy for active surveillance

PSA every 6 mos
DRE every 12 mos
Repeat prostate biopsy every 12 mos
Repeat mpMRI every 12 mos

*No more often than, unless clinically indicated



PROS-3

11

Adverse features, post-RP, and treatment options if these are present:

1. Positive margins
2. Seminal vesicle invasion
3. Extracapsular extension
4. Detectable PSA

Treatment:
EBRT _+ ADT
OR
Observation



PROS-6

12

Observation definition

Monitoring the course of disease with expectation to deliver palliative therapy for the development of symptoms or change in PSA that suggests symptoms are imminent.

Palliative therapy = Palliative ADT

13

PSA nadir definition

NAY-dur

The lowest PSA value reached after RT.

14

PSA persistence and recurrence after RP

1. Failure of PSA to fall to undetectable levels (persistence)
2. Undetectable PSA after RP that increases on 2 or more determinations (PSA recurrence)

15

PSA persistence/recurrence after RT

PSA increase by 2 ng/mL or more above the nadir PSA

RTOG-ASTRO Phoenix

16

Genetic testing for germline variants should include:

MLH1
MSH2
MSH6
PMS2 (Lynch syndrome)
BRCA1
BRCA2
ATM
PALB2
CHEK2
HOXB13

17

Treatment options for:

Very low risk, life expectancy >=20 y

Active surveillance
EBRT or brachytherapy
RP

18

Treatment options for:

Very low risk, life expectancy 10-20 y

Active surveillance

19

Treatment options for:

Very low risk, life expectancy <10y

Observation

20

Treatment options for:

Low risk, life expectancy >= 10 y

Active surveillance (PREFERRED)
EBRT or brachytherapy
RP

21

Treatment options for:

Low risk, life expectancy <10 y

Observation

22

Treatment options for:

Favorable intermediate risk, life expectancy >=10 y

Active surveillance
EBRT or brachytherapy alone
RP _+ PLND if probability of LN mets >= 2%

23

Treatment options for:

Favorable intermediate risk, life expectancy < 10y

EBRT or brachytherapy alone
Observation (preferred)

24

Treatment options for:

Post-RP, positive LN mets, no adverse features

ADT (CATEGORY 1)
_+ EBRT (CATEGORY 2B)

OR

Observation

25

Treatment options for:

Unfavorable intermediate risk, >= 10 y life expectancy

RP_+PLND if predicted probability of LN mets _>2%

EBRT + ADT (4-6 mos)
or
EBRT + brachytherapy _+ ADT (4-6 mos)


PROS-6

26

Treatment options for:

Unfavorable intermediate, <10 y life expectancy

EBRT +ADT (4-6 mos)
or
EBRT + brachytherapy _+ ADT (4-6 mos)

Observation


PROS-6

27

Treatment options for:

High or very high risk, >5 y life expectancy

EBRT + ADT (1.5 - 3 y; category 1 ADT) + docetaxel (cat 1, for very high risk)

EBRT + brachytherapy + ADT (1-3 y; category 1 for ADT)

RP + PLND


PROS-7

28

Treatment options for:

High or very high risk, <= 5y and asymptomatic

Observation
or
ADT
or
EBRT

29

Initial management for:

PSA persistence/recurrence after RP

PSADT

Look for distant mets:

Bone imaging
Chest CT
Abdominal/pelvic CT or MRI
C-11 choline or F-18 fluciclovine PET/CT or PET/MRI
Prostate bed biopsy suggests local recurrence

If (-) distant mets/no imaging done: EBRT + ADT then wait for progression

If (+) mets: M1 na


PROS-11

30

Treatment options for:

M0, castration-naïve

Observation (preferred)
or
ADT



PROS-13