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Expert guideline-based definitions of intermediate-risk prostate cancer and recommendations for active surveillance

Expert guideline-based definitions of intermediate-risk prostate cancer and recommendations for active surveillance
Guidelines Intermediate-risk criteria Active surveillance recommendations
PSA (ng/mL) Pathology Clinical stage Favorable intermediate-risk Candidates for surveillance Surveillance protocol
2018 ASCO[1] 10-20 -or- Gleason score 7 -or- cT2b Endorses AUA/ASTRO/SUO guidelines 'Select' favorable intermediate-risk patients, including select patients with low volume, intermediate-risk (grade group 2) localized prostate cancer PSA every 3 to 6 months, yearly DRE, confirmatory TRUS biopsy within 6 to 12 months and every 2 to 5 years thereafter or more frequently if clinically indicated with consideration of MRI and genomic testing
2021 EAU/EANM/ESTRO/ESUR/SIOG[2] 10-20 -or- Grade group 2 or 3 -or- cT2b Not specified 'Highly selected' intermediate-risk patients with <10% pattern 4 No schedule specified
2022 NCCN (v 1.2022)[3] 10-20 -or- Grade group 2 or 3 -or- cT2b/2c No more than single intermediate-risk factor, grade group 1 or 2, and <50% positive biopsy cores Favorable intermediate-risk patients PSA no more than every 6 months and DRE, repeat biopsy, and repeat MRI no more than every 12 months unless clinically indicated
2022 AUA/ASTRO[4,5] 10-20 -or- Grade group 2-3 -or- cT2b-c PSA 10-<20 ng/mL and grade group 1, or clinical stage T2b-c and <50% biopsy cores positive or PSA <10 ng/mL with grade group 2 and clinical stage T1-2a and <50% biopsy cores positive Favorable intermediate-risk patients No specified surveillance intervals but PSA no more frequently than every 6 months and individualized monitoring regimen based upon estimated risk of recurrence.
PSA: prostate-specific antigen; ASCO: American Society of Clinical Oncology; AUA: American Urological Association; ASTRO: American Society for Radiation Oncology; SUO: Society of Urologic Oncology; DRE: digital rectal examination; TRUS: transrectal ultrasound; MRI: magnetic resonance imaging; EAU: European Association of Urology; EANM: European Association of Nuclear Medicine; ESTRO: European Society Radiation Oncology; ESUR: European Society of Urogenital Radiology; SIOG: Society of Geriatric Oncology; NCCN: National Comprehensive Cancer Network.
References:
  1. Bekelman JE, Rumble RB, Chen RC, et al. Clinically localized prostate cancer: ASCO clinical practice guideline endorsement of an American Urological Association/American Society for Radiation Oncology/Society of Urologic Oncology Guideline. J Clin Oncol 2018; 36:3251.
  2. Mottet N, van den Bergh R CN, Briers E, et al. EAU-EANM-ESTRO-ESUR-SIOG Guidelines on Prostate Cancer-2020 Update. Part 1: Screening, Diagnosis, and Local Treatment with Curative Intent. Eur Urol 2021; 79:243.
  3. NCCN Clinical Practice Guidelines in Oncology: Version 1.2022. Available at: http://www.nccn.org/professionals/physician_gls/f_guidelines.asp (Accessed September 29, 2021).
  4. Eastham JA, Auffenberg GB, Barocas DA, et al. Clinically localized prostate cancer: AUA/ASTRO Guideline, Part I: Introduction, risk assessment, staging, and risk-based management. J Urol 2022; 208:10.
  5. Eastham JA, Auffenberg GB, Barocas DA, et al. Clinically localized prostate cancer: AUA/ASTRO Guideline, Part II: Principles of active surveillance, principles of surgery, and follow-up. J Urol 2022; 208:19.

Adapted and updated from: Overland MR, Washington SL 3rd, Carroll PR, et al. Active surveillance for intermediate-risk prostate cancer: yes, but for whom? Curr Opin Urol 2019; 29:605.

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