Prostate Cancer, cancer, Stacy Loeb, biopsy results, Vanderbilt University, National Cancer Institute, PSA level, digital rectal examination, prostate biopsy, PSA screening, William J. Catalona, National Cancer Institute�designated Comprehensive Cancer Centers, Prostate-specific antigen, the Cover Vanderbilt-Ingram Cancer Center Vanderbilt-Ingram Cancer Center, Southern Community Cohort, Nashville, Tennessee, translational research, Access Center, clinical care, Jennifer A. Pietenpol, Vanderbilt-Ingram, research program, research programs, southeastern United States, MD Guidelines, Clinical Practice Guidelines, population screening, unnecessary procedures, Prostate Cancer Phillip J. Saylor, lifetime risk, Detection Guidelines, National Comprehensive Cancer Network, Prostate Cancer Treatment, NCCN Guidelines, prostate cancer screening, Androgen Deprivation Therapy, James L. Mohler, Benefits Matthew E. Nielsen, Bruce J. Trock, adjuvant radiotherapy, Matthew R. Smith, MD, NCCN News, Patrick C. Walsh, MD, MD Mark H. Kawachi, ADT, NCCN Clinical Practice Guidelines, Adverse Effects, pathologic features
Volume 8 Number 2
JNCCN Journal of the National Comprehensive Cancer Network
NCCN Clinical practice guidelines
in OncologyTM 162 prostate cancer
In the late 1980s and early 1990s, the number of newly diagnosed prostate cancers in U.S. men increased dramatically, and prostate cancer surpassed lung cancer
as the most common cancer in men. However, a comparatively low death rate suggests that increased public awareness with earlier detection and treatment has begun to affect mortality from this prevalent cancer. At the same time, early detection and treatment of prostate cancers that do not threaten life expectancy result in unnecessary side effects
. Important changes to the NCCN Guidelines for prostate cancer for 2010 include the addition of a treatment pathway for patients with very low risk of recurrence and expected survival less than 20 years and updates to recommendations for biopsy. 240 Prostate Cancer Early Detection The NCCN Prostate Cancer Early Detection Guidelines provide a set of sequential recommendations detailing a screening and subsequent workup strategy to maximize the detection of prostate cancer in an early, organ-confined state while attempting to minimize unnecessary procedures. These guidelines were developed for men who have elected to participate in prostate cancer screening; they are not meant to address the controversy regarding population screening. The 2010 version of the NCCN Guidelines contain several critical updates, including consideration of the European Randomized Study of Screening for Prostate Cancer (ERSPC) in the recommendations. Special Feature 148 A Method for Using Life Tables to Estimate Lifetime Risk for Prostate Cancer Death Hyung L. Kim, MD; Marvin R. Puymon, FSA, MAAA; Maochun Qin, MD; Khurshid Guru, MD; and James L. Mohler, MD Prostate cancer can have a long and indolent course, and management without curative therapy should be considered in select patients. Estimating a patient's lifetime risk for dying from prostate cancer is a useful way to convey the risk of death from competing causes when counseling patients. Double-decrement life tables were constructed to calculate age-specific death rates, which provide life expectancy and risk for prostate cancer death based on age at diagnosis. this article
discusses a Web-based tool for performing the calculations. Featured Articles 201 Appropriate Use of Nomograms to Guide Prostate Cancer Treatment Selection Andrew K. Lee, MD, MPH, and Christopher L. Amling, MD Basic clinical factors allow physicians some ability to predict possible outcomes for prostate cancer, but the basic tables and risk stratification provide only a broad range of potential outcomes. The rapid growth of retrospective research has yielded many additional potential prognostic factors, but understanding their significance is difficult. Nomograms incorporate these factors to distill large numbers of data into a manageable format and provide the probability of outcomes on a continuous scale rather than in categorical groups. This article reviews the effective use of nomograms in determining appropriate prostate cancer treatment.
About the Cover Vanderbilt-Ingram Cancer Center Vanderbilt-Ingram Cancer Center (www. vicc.org) in Nashville, Tennessee, is one of a select few National Cancer Institutedesignated Comprehensive Cancer Centers in the southeastern United States and the only one in Tennessee that conducts research and provides care for adult and pediatric patients. Established in 1993, Vanderbilt-Ingram brings together the cancer-related research, clinical care, education, prevention, and outreach activities of Vanderbilt University
. Its nearly 300 members in 7 research programs generate more than $160 million in annual federal grant support. Vanderbilt-Ingram ranks among the top 10 centers measured by competitive funding from the National Cancer Institute. Led by Jennifer A. Pietenpol, PhD (second photo on the cover), as its director, Vanderbilt-Ingram is a major cancer referral center in the Southeast, with about 4,500 new cancer patients
entered into its Cancer Registry each year. Known for a culture of collegiality, the center focuses its efforts on high-impact basic and translational research and high-quality multi-disciplinary care, with particularly strong programs in thoracic, head and neck, breast, gastrointestinal, hematologic, and genitourinary malignancies, as well as melanoma and sarcomas. The center is also known for a strong epidemiology and populationbased research program, including the Southern Community Cohort, the only such longitudinal study of the burden of cancer among African American
s. The study has 90,000 enrollees in the Southeast and large cohorts in Asia, Europe, and South America
. Its new REACH for Survivorship Program partners with referring physicians to offer guidance to a "new normal" for cancer survivors after treatment, regardless of age at diagnosis, type of cancer, or where treatment was received. More info at www. vicc.org/cancersurvivor. The Center has recently launched a new Access Center to streamline appointments and access for patients and referring clinicians. The toll-free number for patients is 877-936-VICC; for clinicians, 877-6MD-VICC; and for clinical trials information, 800-811-8480.
Issue Editors James L. Mohler, MD Mark H. Kawachi, MD
Editorial The 2010 NCCN clinical practice guidelines
in Oncology on Prostate Cancer James L. Mohler, MD Guidelines Updates
xxx Upcoming Events
xxxvii NCCN News
211 Adverse Effects of Androgen Deprivation Therapy: Defining the
Problem and Promoting Health Among Men with Prostate Cancer
Phillip J. Saylor, MD, and Matthew R. Smith, MD, PhD Androgen deprivation therapy (ADT) plays a central role in the management of locally advanced, recurrent, and metastatic prostate cancer. Because most men diagnosed with prostate cancer will die of something other than their cancer, treatment-related adverse effects are highly relevant to their long-term health. Benefits of ADT in each clinical setting must be weighed against ADT-related adverse effects, and data-driven recommendations for managing these adverse effects are needed.
228 Salvage or Adjuvant Radiation Therapy: Counseling Patients on the Benefits
Matthew E. Nielsen, MD; Bruce J. Trock, PhD; and Patrick C. Walsh, MD Recent developments in the urologic oncology literature suggest that postoperative radiotherapy may benefit patients with adverse pathologic features or biochemical recurrence after radical prostatectomy. However, whether all patients with these features should undergo immediate adjuvant radiotherapy versus initial observation with more selective radiotherapy if needed remains the subject of heated controversy. This article reviews salient recent studies to address important questions relevant to counseling patients.
265 Prostate Cancer Screening and Determining the Appropriate ProstateSpecific Antigen Cutoff Values
William J. Catalona, MD, and Stacy Loeb, MD Prostate-specific antigen (PSA) in combination with digital Rectal examination
forms the basis for current prostate cancer screening programs. Although PSA screening was recently shown to reduce prostate cancerspecific mortality, its limitations include the risk of unnecessary prostate biopsy and the diagnosis and treatment of cancers that might never have been symptomatic. A potential way to minimize these pitfalls is through the use of PSA derivatives, particularly PSA kinetics, to increase the specificity for clinically relevant prostate cancer.
271 Use of Nomograms for Early Detection in Prostate Cancer
Devon C. Snow, MD, and Eric A. Klein, MD The accurate diagnosis of clinically significant prostate cancer remains a challenge. Analysis of a correlation between prostate specific antigen (PSA) levels and biopsy results in the placebo group of a recent trial suggests that no "normal" PSA level exists. Acknowledging that PSA level is a continuum rather than a dichotomous marker makes accurately diagnosing clinically significant prostate cancer even more challenging. Nomograms are increasingly being used as tools in the clinical setting to address this challenge. This article discusses the rational for the use of nomograms and the advantages and limitations for the most commonly used nomograms.