Treatment Algorithm - Flowchart
Treatment Algorithm - Flowchart Prostate Cancer Prostate Cancer
«Flowchart»

Start

Start

Start

Initial diagnosis: Serum prostate-specific antigen (PSA), digital rectal examination, prostate biopsy with Gleason score, and family history

Initial diagnosis: Serum prostate-specific antigen (PSA), digital rectal examination, prostate biopsy with Gleason score, and family history

Initial diagnosis

Locally advanced: Stage T3b-T4, Gleason score 8-10, PSA >20 ng/ml

Locally advanced: Stage T3b-T4, Gleason score 8-10, PSA >20 ng/ml

Locally advanced

Further disease progression

Further disease progression

Further disease progression

Local therapy

Local therapy

Local therapy

End

End

End

Adjuvant external beam radiation with or without androgen deprivation for adverse features

Adjuvant external beam radiation with or without androgen deprivation for adverse features

Adjuvant external beam radiation with or without androgen deprivation for adverse features

Persistently elevated or rising PSA: Imaging studies for sites of disease

Persistently elevated or rising PSA: Imaging studies for sites of disease

Persistently elevated or rising PSA: Imaging studies for sites of disease

Androgen deprivation (and radiation to symptomatic or weight-bearing bone sites of disease) with or without an antiandrogen or docetaxel

Androgen deprivation (and radiation to symptomatic or weight-bearing bone sites of disease) with or without an antiandrogen or docetaxel

Androgen deprivation (and radiation to symptomatic or weight-bearing bone sites of disease) with or without an antiandrogen or docetaxel

Androgen deprivation with or without an antiandrogen or observation

Androgen deprivation with or without an antiandrogen or observation

Androgen deprivation with or without an antiandrogen or observation

Disease progression

Disease progression

Disease progression

Disseminated nonmetastatic:

Disseminated nonmetastatic:

Disseminated nonmetastatic

Metastatic:

Metastatic:

Metastatic

Radical prostatectomy

Radical prostatectomy

Radical prostatectomy

Radiation therapy with or without androgen deprivation

Radiation therapy with or without androgen deprivation

Radiation therapy

Low or very low risk: Stage T1-T2a, Gleason score 6, and PSA <10 ng/ml

Low or very low risk: Stage T1-T2a, Gleason score 6, and PSA <10 ng/ml

Low or very low risk

Intermediate risk: Stage T2b-T2c, Gleason score 7, or PSA 10-20 ng/ml

Intermediate risk: Stage T2b-T2c, Gleason score 7, or PSA 10-20 ng/ml

Intermediate risk

High risk: Stage T3a, Gleason score 8-10, or PSA >20 ng/ml

High risk: Stage T3a, Gleason score 8-10, or PSA >20 ng/ml

High risk

Castration resistant:

Castration resistant:

Castration resistant:

Radiation therapy with androgen deprivation

Radiation therapy with androgen deprivation

Radiation therapy with androgen deprivation

Metastatic:

Metastatic:

Metastatic

Maintain androgen deprivation, second-line hormonal therapy (abiraterone/enzalutamide), chemotherapy, 223Ra for symptomatic bone metastasis, zoledronic acid/denosumab to prevent bone resorption, clinical trial

Maintain androgen deprivation, second-line hormonal therapy (abiraterone/enzalutamide), chemotherapy, 223Ra for symptomatic bone metastasis, zoledronic acid/denosumab to prevent bone resorption, clinical trial

223 Maintain androgen deprivation

Age and life expectancy

Age and life expectancy

Age and life expectancy

Active surveillance

Active surveillance

Active surveillance

Local therapy

Local therapy

Local therapy