Page 1 - CUA ESMO ToolCard WEB
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PROSTATE CANCER: ESMO CLINICAL PRACTICE TREATMENT GUIDELINES 1
Interpreting the guidelines for Canadian health care providers 2,3
LOCALIZED PCa
VERY LOW RISK* LOW RISK* INTERMEDIATE RISK* HIGH RISK* VERY HIGH RISK*
All of: • T1c • GG 1 All of the following No high-risk features and 1-3 of: 0 very high-risk features and ≥ 1 of: • T3b–T4
• PSA < 10 ng/mL but does not qualify • T2b–T2c • GG 2–3 • PSA 10–20 exactly 1 of • Primary GS 5
• < 3 prostate biopsy for very low risk:
fragments/cores positive, • T3a • GG 4 or 5 • > 4 cores with
≤ 50% cancer in each • T1-T2a • GG 1 • PSA > 20 ng/mL GG 4 or 5
fragment/core • PSA < 10 ng/mL FAVOURABLE UNFAVOURABLE
• PSA density < 0.15 ng/mL/g All of: • 1 IRF • GG 1 or 2 ≥ 1 of: • 2–3 IRFs • GG 3
• < 50% biopsy cores positive • ≥ 50% positive biopsy cores
EBRT + ADT RP + Watchful
(18-36 months) PLND waiting
Consider ADT for
RT (EBRT,
Active Watchful 4-6 months
surveillance brachytherapy, RP waiting
or SABR)
ADT Androgen deprivation therapy RP ± RT (EBRT, Watchful
ARAT Androgen receptor-axis-targeted therapy PLND brachytherapy, waiting
CRPC Castration-resistant prostate cancer or SABR)
EBRT External beam radiation therapy
GG Grade group
GS Gleason score RELAPSE AFTER RADICAL THERAPY See metastatic castrate sensitive prostate cancer
HIFU High-intensity focused ultrasound
IRF Intermediate risk factor After RT After RP Metastases:
PCa Prostate cancer YES Continuous ADT ± ARAT,
PLND Pelvic lymphadenectomy docetaxel, or EBRT
PSA Prostate-specific antigen
RP Radical prostatectomy Local salvage (HIFU, brachytherapy, Early salvage RT to prostate bed ± pelvic Watchful waiting or
RT Radiotherapy cryotherapy, RP ± PLND) nodes (consider ADT for 6-24 mos), NO intermittent ADT
SABR Stereotactic ablative radiotherapy or watchful waiting or watchful waiting
*Definitions of risk are from NCCN Guidelines 4
