Clinical Guidelines for Prostate Cancer

Clinical guidelines for prostate cancer vary depending on the organization issuing them, but they generally include the following:

Screening. The American Cancer Society (ACS) recommends that men talk to their doctor about whether to get screened for prostate cancer. Men should begin the discussion at age 50 if they are at average risk for prostate cancer. African American men and men with a family history of prostate cancer should start the discussion at age 45. Men with an even higher risk (more than one first-degree relative who had prostate cancer at an early age) should begin the discussion at age 40.

Diagnosis. If a man’s PSA level is elevated, he may need to undergo further testing, such as a digital rectal exam (DRE) or a prostate biopsy.

Staging. Once a man is diagnosed with prostate cancer, his cancer will be staged to determine how far it has spread. The stages of prostate cancer are:

Localized. The cancer is confined to the prostate gland.

Regional. The cancer has spread to the tissues surrounding the prostate gland.

Distant. The cancer has spread to other parts of the body, such as the bones or lymph nodes.

Treatment. The treatment for prostate cancer depends on the stage of the cancer, the patient’s age and health, and his personal preferences. Treatment options include:

Active surveillance. This is a watch-and-wait approach for men with low-risk prostate cancer. Men who choose active surveillance will have their PSA levels and DREs checked regularly to monitor the cancer.

Radiation therapy. This treatment uses high-energy beams to kill cancer cells. Radiation therapy can be used to treat localized prostate cancer or to relieve symptoms in men with advanced prostate cancer.

Hormone therapy. Hormone therapy blocks the production of testosterone, which can help to shrink prostate cancer cells. Hormone therapy is often used in combination with other treatments, such as radiation therapy or surgery.

Surgery. This treatment removes the prostate gland. Surgery is often used to treat localized prostate cancer.

Chemotherapy. Chemo is sometimes used if prostate cancer has spread outside the prostate gland and hormone therapy isn’t working. Chemo may also be helpful if given along with hormone therapy.

Cryotherapy. Also known as cryosurgery or cryoablation, cryotherapy is a treatment option for prostate cancer where extreme cold is used to kill cancer cells. Cryotherapy is sometimes used if the cancer has come back after radiation therapy.

Immunotherapy. This is the use of medicines to stimulate a person’s own immune system to recognize and destroy cancer cells more effectively. Certain types of immunotherapy can be used to treat prostate cancer, including a cancer vaccine (Provenge) and immune checkpoint inhibitors (Keytruda).

Targeted drug therapy. This type of cancer treatment uses drugs or other substances to precisely identify and attack certain types of cancer cells. Examples include PARP inhibitors (Rubraca, Lynparza, Talzenna).

The clinical guidelines for prostate cancer are constantly evolving as new research is conducted. It is important to talk to your doctor about the latest guidelines and how they apply to your individual situation.