New NCCN Guidelines Advise More Doctor-Patient Interaction

Hello All,

Sorting out all the conflicting info on PC and making treatment
decisions is much more of a burden for the Pca patient because there
is so much disagreement about everything.

I read a professional opinion that estimated that *only 13%* of men
who are diagnosed with PC are equipped to make a sound decision
because they have reviewed the right info and then evaluated all of it
*with their doctor*. Unfortunately, it is not just a question of
doing your homework

Anyway, the new NCCN has just issued Practice Guidelines which try to
address this problem. (I am going to give a little intro on this
subject and then present the guidelines themselves as summarized by
the NCCN.)

If you are not familiar with it, the NCCN, it is an org. comprised of
19 prestigious cancer centers in the country. Their website,
nccn.org, has a ton of good info (you might also want to read the info
for doctors). They also issue guidelines for clinical practice, which
are widely followed by doctors. These are revised every year.

This newest guidelines specifically address the problem of there being
no consensus on PC treatment, and stresses that it is critical for
doctors to spend more time with the patient discussing the different
options.

**So, in this years clinical practice guidelines, it says that:

* They have completely reworked the risk/benefit section, which now
includes "talking points" that the patient should discuss with the
doctor before he makes a decision at any stage of the treatment. *
There are also "decision trees" which are easy-to-follow, step-by-step
diagrams which help you determine what treatment might be appropriate
for you.* And they are very specific.

The new Guidelines also stress the need for a multi-disciplinary
approach to treating PC, and suggest that the newly diagnosed patient
be evaluated by a team of specialists. They recommend that this
become standard procedure.

The NCCN guidelines also strongly advise that the doctor explain to
the patient, as best as she could and based on what reliable info is
available, how their PSA level and Gleason score might affect their
outlook for long-term survival and recurrence. And, they docs should
discuss the pros and cons of treatments in terms of quality of life.

I think this is so important because It is a real burden for PC
patients to make decisions about treatment, because even the NCI calls
this whole area a "morass". To make an informed decision, you would
really need to spend a lot of time with your doctor doing nomograms
and reviewing data. And some of this data is known to be unreliable.

Because of this, *even the most diligent PC patient may not have
enough sound information to make the right decision.* I know I
didn't. So sometimes I think we should have done things differently,
but I don't think even Einstein could have sorted it all out. So, I
don't blame myself for anything.

Be sure to read the "Early Detection" talking points.

Anyway, following are excerpts from the actual NCCN report:

Good Night, all.

Leah

[I am including all of the guidelines, including those pertaining to
other topics, because they might be of use to someone else.]

(I'm sorry if this msg itself is a morass, but I'm tired.)

************************************************** *************

NCCN Updates Prostate Cancer Guidelines

JENKINTOWN, Pa., January 29, 2007 — The National Comprehensive Cancer
Network (NCCN) announces updates to the NCCN Prostate Cancer
Guidelines. The NCCN Clinical Practice Guidelines in Oncology™ are
widely recognized and applied as the standard for clinical care in
oncology in both the community practice setting and in academic cancer
centers.

The panel of expert physicians from NCCN Member Institutions revised
their recommendations regarding pelvic lymph node dissection. Robotic
techniques are now accepted for both pelvic lymph node dissection and
radical prostatectomy. According to the panel, in experienced hands,
the results of this approach appear comparable to open surgical
techniques.

***In addition, the guidelines now include a Principles of Life
Expectancy Estimation section. Life expectancy is the basis of the
initial clinical assessment and is critical to informed decision
making in prostate cancer early detection and treatment. The
combination of risk of recurrence and life expectancy estimation is a
deciding factor for initial therapy.***

The panel also recommends that bisphosphonate therapy should be
considered in patients with castration-recurrent metastatic prostate
cancer since it may prevent skeletal-related events and improve bone
mineral density.

NCCN Clinical Practice Guidelines in Oncology™ are developed and
updated continuously through a consensus-driven process with explicit
review of the scientific evidence. The most recent version of this and
all the guidelines are available free of charge at www.nccn.org.

For questions about NCCN or for interview information, please contact
Thomas Mitchell at 215.690.0245.