Prostate Cancer
Practice guideline development methods were set forth by the Agency for Healthcare Research and Quality. Multidisciplinary efforts of this nature are centered on analysis of existing scientific outcome and technology assessment studies in an environment of consensus building. Clinical practice guidelines so derived are meant to apply to most, but not all, patients with the specified condition. Nonetheless, it is essential that patient evaluation and management decisions are made in light of all circumstances present in an individual case. In this context, the ACR, the AUA, the ACS, and the NCCN provided management pathways relevant to pretherapy evaluation, radiotherapeutic care, post-therapy surveillance, and salvage therapy for patients with prostate cancer. Application of these guidelines will not necessarily ensure optimal outcome, so the clinician must exercise independent medical judgment to determine an individual patient's best care program. Likewise, as new studies are reported and more current information emerges, this must drive diagnostic and treatment decisions because formal guidelines are only updated periodically. There has been a rapidly advancing technologic revolution in diagnostic imaging and radiation treatment secondary to computer-driven applications that can quickly make adopted guidelines and recommendations obsolete.
The most recent NCCN recommendations are presented in Figure 51-23 . In recent years the trend has been toward evidence-based medicine tailored as much as possible for the individual patient. This is especially pertinent in cancer care where studies, both prospectively randomized and retrospective, often provide generalized information for a disease, which can have significantly diverse variables in select populations and individuals.
