After making an unpopular change in September of an established recommendation on the use of active surveillance in men with prostate cancer, the National Comprehensive Cancer Network (NCCN) has reversed course and reinstated its original recommendation, but with a slight change.
The influential cancer organization that is most well-known for its guidelines, suggests that “most” men with a low risk of prostate cancer be given active surveillance as the sole “preferred” treatment option. This recommendation is in complete agreement with the original recommendation of the group that was published more than a decade ago.
The NCCN changed its mind on active surveillance in September. It recommended that people who have low-risk illnesses be treated with active surveillance, radiation treatment or surgery with equal weight.
The new advice has angered doctors who support the concept of active surveillance, which aims to delay or prevent treatment — and possibly life-threatening side effects — until signs of disease progress.
The NCCN listened to the complaints.
Today, the group largely reverted back to the initial recommendation. In the updated guidelines, active monitoring was reaffirmed as the only “preferred” management option for men with low-risk illnesses. However, it is not recommended for all men.
In an email sent to Medscape Medical News, Edward Schaeffer, MD, PhD, chair of the prostate cancer treatment panel, stated that “the NCCN Prostate Cancer Panel recently convened” and “extensively reviewed the Principles of Active Surveillance and Observation.”
Schaeffer is a researcher at the Lurie Comprehensive Cancer Center of Northwestern University in Chicago, highlighted the heterogeneity in the low-risk disease category. He added that factors that contribute to an increased likelihood of a short-term grade classification from low high risk to higher risk include high PSA density, a high number of positive cores (>=3), high genomic risk (from molecular tumor tissue analysis) and/or a confirmed BRCA2 mutation.
Today’s NCCN reverse was celebrated by urologists via Twitter.
“Big news! NCCN guidelines have been updated active surveillance is ‘preferred for patients with prostate cancer at low risk and life expectancy greater than 10 years,” tweeted Stacy Loeb of NYU Langone in New York City.
Big news! NCCN guidelines updated again- active surveillance is “preferred for most patients” with low risk #prostatecancer and life expectancy of >=10y. Full version 2.2022 available online with free login: https://t.co/6G5Ya5VEPK https://t.co/J6PFcl1B8G
— Stacy Loeb, MD (@LoebStacy) November 30, 2021
“Very exciting if true,” tweeted Matthew Cooperberg, MD, of University of California San Francisco, who was one of the most vocal critics of NCCN’s change in September, describing the move an “step backward” which could cause excessive treatment.
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