Page 11 - PRESENTATION

NCCN Guidelines

Initial Risk Stratification and Staging Workup for Clinically Localized Disease

Molecular and
Germline
Risk group Clinical/pathologic features Imaging f,g biomarker analysis
testing
of tumor c

• Bone imaging : not recommended for
h
Has all of the staging Recommended if

following: • Pelvic ± abdominal imaging: family history
i
• 1 IRF positive or
Favorable • Grade Group recommended if nomogram predicts intraductal/ Consider if life
intermediate >10% probability of pelvic lymph node expectancy ≥10y j
Has all of the following: 1 or 2 involvement cribriform

• No high- or very-high- • <50% biopsy • If regional or distant metastases are histology
risk group features cores positive e found, see PROS-8 See PROS-1

Intermediate d • Has one or more
h
intermediate risk factors Has ≥1 of the • Bone imaging : recommended if T2 and Recommended if

(IRF): following: PSA > 10 ng/mL family history
i
• T2b-T2c • 2 or 3 IRFs • Pelvic ± abdominal imaging: positive or

• Grade Group 2 Unfavorable • Grade Group recommended if nomogram predicts intraductal Consider if life

or 3 intermediate 3 >10% probability of pelvic lymph node histology expectancy ≥10y j
• PSA 10-20 • ≥50% biopsy involvement See PROS-1

ng/mL cores positive e • If regional or distant metastases are
found, see PROS-8

h
• Bone imaging : recommended
i
• Pelvic ± abdominal imaging:
Has no very-high-risk features and has at least one high-risk
feature: recommended if nomogram predicts

High • T3a OR >10% probability of pelvic lymph node Recommended Consider if life j
involvement
expectancy ≥10y
• Grade Group 4 or Grade Group 5 OR • If regional or distant metastases are
• PSA >20 ng/mL
found, see PROS-8

12 NCCN Clinical Practice Guidelines in Oncology Prostate Cancer Version 2.2020