NCCC – Clinical Practice Guidelines – Prostate Cancer

Authors : National Council on Cancer Care – Singapore

References

Level of evidence (1 – IV) including 168 references.

Grade

Grade of recommendations (A – C) with Good Practice Points (GPP)

Coverage

The choice of treatment for localized prostate cancer should be individualized and based on an assessment of the biological potential of the disease, the life expectancy of the patient and the preference of the patient.

• Surveillance – the absence of complications compared to conventional radiotherapy or radical surgery and the minimal costs involved are the potential benefits for patients with low grade, low volume tumours and elderly patients with limited life expectancy.
  
  
• Surgery - patients most likely to benefit from surgery are those with clinically organ-confined disease, a relatively long life expectancy, no significant surgical risk factors and a preference to undergo surgery. Radical prostatectomy should be considered in particular for the high-risk group (i.e. Gleason’s sum >6, stage T2c or PSA<20 ng/ml).
  
  
• Radiotherapy – despite the differences in case selection and the lack of surgical staging of the lymph nodes in most cases, the long term results of radiotherapy in stage T1 and T2 patients are similar to those reported with radical prostatectomy
  
  
• Hormonal therapy - this remains the mainstay of treatment for metastatic prostate cancer. Surgical castration is equal in efficacy compared with other means of medical castration, including total androgen blockage.