NCCN Guideline on P Ca v1- 2022

• 23 Nov 2021 10:12:49 AM
• |Onco Urology

Dear All,

For over a decade, the influential National Comprehensive Cancer Network (NCCN) has been recommending that men with low-risk prostate cancer be offered active surveillance as the lone ‘preferred’ initial treatment option. But the NCCN has now reversed this long-standing recommendation in the latest revision of its prostate cancer guideline.

The organization now recommends that low-risk disease be managed with either active surveillance or radiation therapy or surgery, with equal weight given to all three of these initial options.

The change is seen by some as a retreat to the past and was harshly criticized by many experts. The complaints were voiced in unusually blunt and strong language.

Notable among them are Andrew Vickers, Alexander Kutikov, Mathew Cooperberg, John Griffith and Benjamin Davies.

Andrew Vickers of MSKCC said that this change is ‘ludicrous’ to say the least. Alexander Kutikov mentioned that these changes ‘seem of the rails’ and he is stunned by it. He also added that this is ‘A huge setback & frankly a disgrace for @NCCN and its processes’. Mathew Cooperberg, a leading researcher in the field of P Ca called the move a ‘step backward’. John Griffith commented that ‘This is a terrible step back that impacts every urologist’. Finally Benjamin Davies wondered ‘if a time warp was at play’. He added scathingly ‘To suggest for a millisecond that active surveillance isn't the preferred method for low-risk men is bizarre thinking…Is this 1980?’. This Guideline on which so many criticisms are laid is not yet available in print.

Should we in India take this guideline changes seriously. Though there are few in India advocating AS for Low Grade low Volume disease, AS requires frequent evaluations and change in policy as required which are hard to implement in India. Most Urologist in India are for RP and those with Robotic Technology at their centres definitely prefer that technology.

But if one scans the literature, it is obvious that RP has its own limitations with many alternatives now being tried with varying success. There have been now studies available that RP in whichever form has reduced takers, making it possible for a possible RPs being performed globally. RT in its various avatars are now gaining popularity and many studies have reported Equal or even Better Results than RPs for localized P Ca’s. We Urologists many not accept this fact but the reality is there for all to see. There is slow but steady surge in various techniques of Focal Therapy. Though still not favoured as the primary treatment by many, there are studies now showing favourable results with 5 years followup.

Will all these developments occurring rapidly change the way we treat P Ca in near future making RPs to take a back seat? This is appoint to ponder.

I am providing the recently Published NCCN Guideline on ‘P Ca Early Detection’. This is worth reading and understanding (PDF provided)

With warm Regards,

Venu

 

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