NCCN Guidelines Influence Community Care, May Result in Less Overdiagnosis of Prostate Cancer

By Emily Menendez - Last Updated: May 10, 2023

A research team from Roswell Park Comprehensive Cancer Center has shown a growing adherence to the National Comprehensive Cancer Network (NCCN) clinical practice guidelines for the diagnosis and treatment of cancer, which may result in better outcomes for patients. For prostate cancer in particular, clinical practice guidelines such as those developed by the NCCN help to avoid the overdiagnosis and overtreatment of cancer that is unlikely to affect a patient’s life expectancy or quality of life.

The research team’s study included 1164 patients with localized prostate cancer who had sought a second opinion at Roswell Park Comprehensive Cancer Center between 2009 and 2019. Each patient case was presented to the NCCN Guideline-compliant Localized Prostate Cancer Conference (LPCC) that included urologists, radiation oncologists, pathologists, and patient advocates. All patient data, including demographics, comorbidity-adjusted life expectancy, prostate-specific antigen (PSA) kinetics, PSA density, NCCN risk group, staging scans, and symptom scores (International Prostate Symptom Score and Sexual Health Inventory for Men) were reviewed.

The patient recommendations based on the NCCN guidelines included active surveillance, radical prostatectomy, radiotherapy with or without androgen deprivation therapy (ADT), ADT alone, or further workup. If more than 1 recommendation was given, the favored option by the full LPCC group was chosen as the final recommendation. If multiple options were offered with no single favored recommendation, they were reported as either “all options” (if active surveillance, radical prostatectomy, or radiotherapy were recommended) or “treatment” (if surgery or radiotherapy were recommended).

The NCCN risk group distributions were 26% very low/low risk, 27% favorable intermediate risk, 25% unfavorable intermediate risk, and 22% high/very high risk. Risk group reclassification occurred in 9% of patients based on pathology review.

During the 10-year study, concordance between community and LPCC recommendations increased over time, from 65% in 2009 to 86% in 2019 (P<.01). The highest agreement was for radical prostatectomy (89%), and the lowest agreements were for ADT monotherapy (21%) and radiotherapy (53%). The number of patients who chose to receive the treatment recommended by their community urologists also rose, from 59% in 2009 to 70% in 2019.

Dr. Khurshid Guru, chair of the Department of Urology at Roswell Park Comprehensive Cancer Center, said that “trend toward agreement resulted in fewer patients undergoing unnecessary testing and treatment, with associated added costs and side effects that can significantly impact the patient’s quality of life.”