The National Comprehensive Cancer Network (NCCN) annually updates its guidelines for the early detection of prostate cancer. These guidelines are important because many health insurance companies determine coverage based on NCCN panel recommendations.
The NCCN guidelines address prostate cancer screening in healthy men who choose to participate in early detection. The focus is on minimizing unnecessary procedures and limiting the detection of indolent disease.
The 2016 updates include adding family history of BRCA1/2 genetic mutations to baseline assessment. A new note also indicates that African-American men may require a higher level of vigilance and different considerations when analyzing screening tests results, but the panel does not give separate screening recommendations for these men. The Prostate Health Index (phi) as well as the ConfirmMDx epigenetic prostate cancer screening test may identify men at higher risk, despite a negative biopsy.
Further updates are age stratification for PSA testing, including indications that men at age 60 years or older with a PSA <1 ng/mL have a low risk of metastases or death from prostate cancer and may not need further testing, and increasing the testing interval to 1-4 years for men older than 75 years with a PSA <3 ng/mL and no other indications for biopsy, and a normal DRE.
The updates also discuss approaches to improving biopsy sensitivity, such as using multiparametric MRI scan followed by lesion targeting to maximize the detection of higher-risk disease and limit the detection of low-risk disease.
Dr. Catalona is a panel member of the NCCN Guidelines for Prostate Cancer Early Detection. The guidelines were published in the Journal of the National Comprehensive Cancer Network in May.
*Dr. Catalona’s Prostate Cancer Update Course
Dr. Catalona led the Prostate Cancer Update course at the American Urological Association annual meeting. The course highlighted important findings on prostate cancer published during the last year. The topics are wide-ranging. This issue of QUEST covers some of these articles, which we hope will be of interest to our readers.