Algorithms

Prostate cancer: diagnosis and treatment

© National Collaborating Centre for Cancer

Diagnosis and staging

Men referred with suspected prostate cancer

 Discuss PSA level, DRE findings, co-morbidities, risk factors, history of previous negative
prostate biopsy
 Give men information, support and adequate time to make a decision. Include explanation of the
risks and benefits of prostate biopsy
 Do not automatically offer prostate biopsy on the basis of serum PSA level alone
 Do not offer prostate biopsy for histological confirmation if the clinical suspicion of prostate cancer
is high (a high PSA value and evidence of bone metastases)

Update 2014
Decision to proceed with biopsy
Positive initial biopsy Carry out prostate biopsy following procedure recommended by the Negative initial biospy
PCRMP*
39

Positive re-biopsy

 Determine the provisional treatment  Advise there is still a risk that prostate
intent cancer is present
 Use nomograms to aid decision  Advise the risk is slightly higher if
making, and help predict biopsy results, biopsy showed HGPIN, biopsy showed
Radical treatment intent ASAP, abnormal DRE
No-radical treatment intent^ pathological stage and risk of treatment
failure. Clearly explain the reliability,  Consider multiparametric MRI to
validity and limitations of the prediction determine whether another biopsy is
needed

 Consider multiparametric MRI if knowledge of

 Do not routinely offer imaging to men
the T or N stage could affect management
who are not candidates for radical
 Do not routinely offer isotope bone scans to
treatment
men with low risk localised prostate cancer
 Offer isotope bone scans to
 Do not offer CT of the pelvis to men with low
asymptomatic men on watchful waiting
or intermediate risk localised disease
at high risk of developing bone
 Do not offer PET for prostate cancer in routine
complications
clinical practice

* Undertaking a transrectal ultrasound guided biopsy of the prostate, Prostate Cancer Risk Management Programme, 2006

^ Does not include men on active surveillance