NCCN guidelines suggest rigorous monitoring of active surveillance patients

Updated National Comprehensive Cancer Network guidelines call for more rigorous monitoring of men with prostate cancer undergoing active surveillance and include new treatment options for patients with advanced disease.

In the updated Guidelines in Oncology for Prostate Cancer, which were presented at the 2011 NCCN annual conference in Hollywood, FL, active surveillance monitoring was made more rigorous for men in the very low-risk category. For those with a life expectancy of less than 20 years, PSA must be measured at least every 6 months, a prostate exam must be performed at least every 12 months, and repeat prostate biopsies should be considered as often as every 12 months.

Guidelines panel chair James L. Mohler, MD, noted that there are several conundrums related to active surveillance that complicate the issue, including overtreatment rates, clinical risks associated with prostate biopsies, and differing criteria for active surveillance and disease progression in large clinical series, all of which need to be taken into consideration when making treatment decisions.

"The NCCN Guidelines Panel remains concerned about over-diagnosis and over-treatment of prostate cancer, as growing evidence suggests that over-treatment of prostate cancer commits too many men to side effects that outweigh a very small risk of prostate cancer death," said Dr. Mohler, of Roswell Park Cancer Institute, Buffalo, NY.

Additional updates to the guidelines include the following:

• sipuleucel-T (Provenge) as an immunotherapy option for asymptomatic or minimally symptomatic castration-recurrent metastatic prostate cancer
• cabazitaxel (Jevtana) as a new second-line option for men with castration-recurrent metastatic prostate cancer who fail docetaxel (Taxotere)
• denosumab (Xgeva) as an alternative to zoledronic acid (Zometa) for the prevention of skeletal-related events.