Prostate cancer guidelines 2023

1. Dr Naina Kumar 20.12.22
Carcinoma Prostate
Nccn guidelines

2. Staging

5. • A In radical prostatectomy:
◦ Gleason score should be based on the primary and secondary patterns; if a minor pattern constitutes <
5%, the pattern should be mentioned as a minor (tertiary) pattern; any higher grade minor pattern ≥ 5%
should be incorporated into the Gleason score and ISUP group as the secondary pattern (2019
consensus) (Eur Urol 2018;73:674)
◦ Ex: Gleason pattern 3=96% and pattern 4=4%, Gleason score=3+3=6 with minor (tertiary) 4
◦ Ex: Gleason pattern 3=95% and pattern 4=5%, Gleason score=3+4=7
• In needle biopsy:
◦ Most prevalent pattern is graded as primary and any amount of a worst pattern is graded as secondary
◦ Ex: Gleason pattern 3=96% and pattern 4=4%, Gleason score=3+4=7
◦ Ex: Gleason pattern 3=95% and pattern 4=5%, Gleason score=3+4=7

7. Concept of life expectancy

8. Early detection and screening
• The USPSTF 2018 - include individualized, informed decisionmaking
regarding prostate cancer screening in males aged 55 to 59 years. ( vs
USPSTF 2012)
• Better use of PSA , imaging and biomarkers to improve the specificity of
screening - decrease the risk of overdetection.
• active surveillance in appropriate patients should reduce overtreatment AND
preserve the decrease in prostate cancer mortality.

9. Update April 2022:
• Two trials now demonstrate an overall survival benefit from the addition of a
second systemic agent to ADT plus docetaxel. In the ARASENS trial, the
addition of darolutamide to ADT plus docetaxel improved overall survival and
all secondary endpoints without worsening treatment-related toxicity in men
with metastatic castration-sensitive prostate cancer (CSPC), and the benefits
were similar in most subgroups
• In the PEACE-1 trial, the addition of abiraterone to ADT plus docetaxel also
improved survival over ADT plus docetaxel alone in patients with de novo
metastatic CSPC.

16. Very low risk group and Low risk
group

17. Adverse features?
positive margin(s); seminal vesicle invasion;
extracapsular extension; or detectable PSA.

18. Intermediate risk group- Fav and
Unfav.

19. High risk and very high risk group ,
Regional risk group

20. EBRT + ADT + ABIRATERONE

21. Metastatic ca prostate

36. RT to prostate?

38. CRPC

42. Thank you