Post by Allen on Sept 9, 2014 11:35:52 GMT -8
You can read it here:
NCCN early detection 1.2014.pdf (413.66 KB)
Here's the previous version, if anyone is interested:
NCCN early detection 2.2012.pdf (549.31 KB)
Interestingly, they state upfront that no consensus was reached, so expect it to be different at each NCCN hospital.
Looking it over, some of the major changes from the 2012 version seem to be:
• PSA Velocity eliminated in baseline evaluation, but may be part of overall risk evaluation
• PSA cut points for biopsy are stratified by age
• Age 40 to start discussion of benefits of screening eliminated. Instead, they include a category for 45-49 who would have no further screening if neg DRE and PSA<1
• For men 50+ with neg DRE and PSA<3, periodic screening with no biopsy. However, men at 60 with PSA<1, and at 70 with PSA<3 may need no further screening. Biopsy considered for men 50-70 with PSA>3.
• Positive DRE no longer an automatic indicator for biopsy, although it remains an option.
• Lower PSA limit for a biopsy has been raised from 2.5 to 3.0, although other risk factors (e.g., ethnicity, family history) may be considered. Risk calculators may be used.
• With PSA>3, positive DRE, or other risk factors, biopsy is an option, but no longer mandate. Alternative biochemical tests - PHI, PCA3 (for re-biopsy) & % free PSA - may be considered instead. PSAD not yet recommended as an indicator.
• topical lidocaine followed by a periprostatic nerve block is recommended
I think this is an improvement over their earlier guidelines, which imho led to much over-biopsying. See my earlier post on that subject.
I am saddened that there is no mention made of eliminating BPH and prostatitis as confounders before biopsy is considered.
- Allen
NCCN early detection 1.2014.pdf (413.66 KB)
Here's the previous version, if anyone is interested:
NCCN early detection 2.2012.pdf (549.31 KB)
Interestingly, they state upfront that no consensus was reached, so expect it to be different at each NCCN hospital.
Looking it over, some of the major changes from the 2012 version seem to be:
• PSA Velocity eliminated in baseline evaluation, but may be part of overall risk evaluation
• PSA cut points for biopsy are stratified by age
• Age 40 to start discussion of benefits of screening eliminated. Instead, they include a category for 45-49 who would have no further screening if neg DRE and PSA<1
• For men 50+ with neg DRE and PSA<3, periodic screening with no biopsy. However, men at 60 with PSA<1, and at 70 with PSA<3 may need no further screening. Biopsy considered for men 50-70 with PSA>3.
• Positive DRE no longer an automatic indicator for biopsy, although it remains an option.
• Lower PSA limit for a biopsy has been raised from 2.5 to 3.0, although other risk factors (e.g., ethnicity, family history) may be considered. Risk calculators may be used.
• With PSA>3, positive DRE, or other risk factors, biopsy is an option, but no longer mandate. Alternative biochemical tests - PHI, PCA3 (for re-biopsy) & % free PSA - may be considered instead. PSAD not yet recommended as an indicator.
• topical lidocaine followed by a periprostatic nerve block is recommended
I think this is an improvement over their earlier guidelines, which imho led to much over-biopsying. See my earlier post on that subject.
I am saddened that there is no mention made of eliminating BPH and prostatitis as confounders before biopsy is considered.
- Allen
