Version 2 2019 05 31 19 2019 National Comprehensive Cancer Network NCCN All rights reserved NCCN Guidelines and this illustration may not be reproduced in any form without the express written permission of NCCN NCCN Clinical Practice Guidelines in Oncology NCCN Guidelines Prostate Cancer Early Detection Version 2 2019 May 31 2019 Continue NCCN org NCCN Guidelines Version 2 2019 Prostate Cancer Early Detection Version 2 2019 05 31 19 2019 National Comprehensive Cancer Network NCCN All rights reserved NCCN Guidelines and this illustration may not be reproduced in any form without the express written permission of NCCN NCCN Guidelines Index Table of Contents Discussion Peter R Carroll MD MPH Chair UCSF Helen Diller Family Comprehensive Cancer Center J Kellogg Parsons MD MHS Vice Chair UC San Diego Moores Cancer Center Gerald Andriole MD Siteman Cancer Center at Barnes Jewish Hospital and Washington University School of Medicine Robert R Bahnson MD The Ohio State University Comprehensive Cancer Center James Cancer Hospital and Solove Research Institute Sigrid Carlsson MD Memorial Sloan Ketering Cancer Center Erik P Castle MD Mayo Clinic Cancer Center William J Catalona MD Robert H Lurie Comprehensive Cancer Center of Northwestern University Douglas M Dahl MD Massachusetts General Hospital Cancer Center John W Davis MD The University of Texas MD Anderson Cancer Center Jonathan I Epstein MD The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins Ruth B Etzioni PhD 123 2312 2319 Footnote c was modified If there is a known or suspected cancer susceptibility gene referral to a cancer genetics professional is recommended BRCA1 2 pathogenic mutation carriers have are associated with an increased risk of prostate cancer before age 65 years and prostate cancer in men with germline BRCA2 mutations occurs earlier and is more likely to be associated with prostate cancer mortality Information regarding germline mutations should be used as part of the discussion about prostate cancer screening Consequently it is reasonable for men with germline BRCA1 2 mutations to consider beginning shared decision making about PSA screening at age 40 and to consider screening at annual intervals rather than every other year Footnote e was modified Testing after 75 years of age should be done only in very healthy men with little or no comorbidity especially if they have never undergone PSA testing to detect the small number of aggressive cancers that pose a significant risk if left undetected until signs or symptoms develop Footnote g was modified Men 60 years with PSA 75 years of age with a PSA 3 0 ng mL have a very low risk of prostate cancer metastases or death and may be counseled to consider stopping PSA testing This low risk is especially true for those in the latter category Men aged 60 years with serum PSA 1 0 ng mL have a very low risk of metastases or death due to prostate cancer A PSA cut point of 3 0 ng mL at age 75 years also carries a low risk of poor outcome PROSD 3 Added TRUS or transperineal guided biopsy with MRI targeting as an option under Management Removed TRUS Guided Biopsy text box Footnote j was modified to use the International Society of Urological Pathology ISUP Grade Group designations rather than Gleason score Added the following reference to footnote j Kasivisvanathan V Ranniko A Borghi M et al MRI targeted or standard biopsy for prostate cancer diagnosis N Engl J Med 2018 378 1767 1777 Footnote i was modified Biomarkers that improve the specificity of detection are not as yet recommended mandated as first line screening tests in conjunction with serum PSA However there may be some patients who meet PSA standards for consideration of prostate biopsy but for whom the patient and or the physician wish to further define the probability of high grade cancer A percent free PSA 35 EPI score greater than 15 6 or 4Kscore which provides an estimate of the probability of high grade prostate cancer are potentially informative in patients who have never undergone biopsy or after a negative biopsy a PCA3 score 35 is potentially informative after a negative biopsy The predictive value of the serum biomarkers discussed above has not been correlated with that of MRI Therefore it is not known how such tests could be applied in optimal combination Footnote m is new A negative MRI does not exclude the possibility of cancer Consider biomarkers and or PSA density when deciding whether to avoid a biopsy in a man with a negative mpMRI result Footnote n is new MRI targeting can be considered in those centers with MRI availability and with experience and expertise in MRI interpretation and targeting Updates in Version 1 2019 of the NCCN Guidelines for Prostate Cancer Early Detection from Version 2 2018 include MS 1 The Discussion section has been updated to reflect the changes in the algorithm Printed by Maria Chen on 6 2 2019 10 11 04 PM For personal use only Not approved for distribution Copyright 2019 National Comprehensive