Cancer Guidelines Database

This is a clinical practice guideline for patients with prostate cancer. The guideline examines the diagnosis, classification and staging, treatment, and follow-up of these patients. Quality of life outcomes are also discussed. This is a web-based guideline and may be updated as new evidence arises - this review pertains to the guideline as of February 12, 2021.

This is a clinical practice guideline for men with suspected or recently diagnosed localized prostate cancer. The guideline provides recommendations for the staging and treatment of these patients, with treatment options stratified based on whether patients have low-risk, intermediate-risk, or high-risk disease. Several treatment approaches are discussed, including active surveillance, radical prostatectomy, low dose rate (LDR) brachytherapy, external beam radiotherapy, whole gland cryosurgery, and whole gland high intensity focused ultrasound (HIFU).

This is a clinical practice guideline for patients with diagnosed or suspected advanced/metastatic prostate cancer. The guideline examines the appropriate staging, treatment and follow-up for this patient population. Management, monitoring, systemic therapy, and radiotherapy are also discussed.

This is a clinical practice guideline for adult men with a suspicion or recent diagnosis of localized prostate cancer. The guideline provides recommendations for the staging, management, and follow-up of these patients. Different management options are provided for patients with low-risk, intermediate-risk, or high-risk disease, and include active surveillance, radiotherapy, and surgery.

This is a clinical practice guideline for patients with advanced prostate cancer, including those with metastatic hormone-sensitive prostate cancer, metastatic castration-resistant prostate cancer, or non-metastatic castration-resistant prostate cancer. The guideline provides recommendations for the diagnosis, staging, and treatment of these patients. Specific topics discussed include early evaluation, counselling, biochemical recurrence, and bone health.

This is a clinical practice guideline for men with advanced prostate cancer, including newly diagnosed clinical high-risk disease, suspected or confirmed metastatic disease, recurrent disease, or progressive disease while under treatment. Recommendations are provided for the optimal use of imaging in this patient population. Conventional imaging (e.g. computed tomography (CT), bone scans, and/or prostate magnetic resonance imaging (MRI)) and next-generation imaging (e.g. positron emission tomography (PET), PET/CT, PET/MRI, and whole-body MRI) are discussed.

This clinical practice guideline is an endorsement of the American Society for Radiation Oncology, American Society of Clinical Oncology, and American Urological Association's 2018 guideline titled Hypofractionated Radiation Therapy for Localized Prostate Cancer: An ASTRO, ASCO, and AUA Evidence-Based Guideline. The guideline examines the use of hypofractionated radiation therapy compared to conventional fractionation in men with localized prostate cancer. Outcomes of interest include prostate control, toxicity, and quality of life.

This is a clinical practice guideline developed for adult men who have elected to participate in an early prostate cancer detection program. The guideline provides a set of sequential recommendations detailing screening and evaluation strategies for maximizing the detection of prostate cancer that is effectively treatable and that, if left undetected, represents a risk to the patient. Several techniques designed to improve the identification of significant cancer, while avoiding the detection of indolent disease, are highlighted, including imaging, biomarker testing, and biopsy.

This clinical practice guideline is for patients with castration-resistant prostate cancer (CRPC). The guideline examines the management options available for these patients. Specific topics addressed include androgen-deprivation therapy (ADT), the addition or change of first-generation androgen receptor antagonists, and non-metastatic CRPC (nmCRPC).

This is a clinical practice guideline for patients with suspected or confirmed prostate cancer. The guideline provides recommendations for diagnosis, including the use of magnetic resonance imaging (MRI) and biopsy, treatment (i.e. radical treatment), follow-up, and active surveillance using multiparametric MRI.

This is a clinical practice guideline for patients undergoing radiation treatment for localized prostate cancer. The guideline examines the use of biodegradable spacers for prostate cancer treatment. A topic of interest is biodegradable spacer insertion as a technology that may be used to decrease toxicity and maintain quality of life (QOL) in appropriately selected patients.

This is a clinical practice guideline for patients with localized prostate cancer who have undergone radical prostatectomy. The guideline focuses on the use of radiotherapy to reduce the risk of prostate cancer recurrence and clinical progression of cancer in these patients, and provides specifications concerning the timing of radiotherapy while emphasizing the importance of communicating the potential risks and benefits to patients.

This is a clinical practice guideline for men with localized prostate cancer. The use of molecular biomarkers for the management of these patients is examined. The guideline specifically discusses patient selection, active surveillance, the identification of clinically significant disease, choosing postprostatectomy adjuvant versus salvage radiotherapy, and emerging questions such as the relative value of tissue biomarkers compared to magnetic resonance imaging (MRI).

This is a clinical practice guideline developed for adult men who have elected to participate in an early prostate cancer detection program. The guideline provides a set of sequential recommendations detailing screening and evaluation strategies for maximizing the detection of prostate cancer that is effectively treatable and that, if left undetected, represents a risk to the patient. Several techniques designed to improve the identification of significant cancer, while avoiding the detection of indolent disease, are highlighted, including imaging, biomarker testing, and biopsy.

This is a clinical practice guideline for patients with metastatic prostate cancer. The guideline examines various therapies for the treatment of metastatic castration-naive and castration-sensitive prostate cancer, including androgen-deprivation therapy, as well as local and external therapies. The prevention of osteoporosis, as well as opportunities for multidisciplinary consultation, are also discussed.

This is a clinical practice guideline for patients with prostate cancer. The guideline examines various treatment options including active surveillance, radical prostatectomy, radiation therapy, other local therapies, androgen deprivation therapy, chemotherapy, and immunotherapy. It also discusses risk stratification, imaging, and estimates of life expectancy. Recommendations are provided for the initial diagnosis, clinical assessment, and staging evaluation, as well as for treatment, which are based on both the level of risk, and specific disease present.

This is a clinical practice guideline on the use of transrectal ultrasound (TRUS)-guided biopsy for the diagnosis of prostate cancer. Pre-biopsy procedures, post-biopsy complications, and techniques used during biopsy are all addressed. Outcomes of interest include patient safety, dignity, and comfort.

This is a clinical practice guideline for patients with prostate cancer. The guideline examines the diagnostic evaluation, classification and staging, treatment, and follow-up of these patients. Treatment for metastatic prostate cancer and castration-resistant prostate cancer are specifically discussed, as is the management of prostate-specific antigen-only recurrence after treatment with curative intent.

This is a clinical practice guideline for patients who have undergone prostate treatment, specifically radical prostatectomy, radiation treatment, or treatment of benign prostatic hyperplasia. The guideline discusses the management of incontinence in these patients. Specific topics addressed include the risk factors for incontinence, assessment of patients prior to intervention, as well as a stepwise approach to management. Treatment options such as physical therapy, medications and surgery are discussed.

This is a clinical practice guideline for patients with high-risk prostate cancer (PCa), defined as PCa patients who have a high probability of relapse, progression, and death from PCa. The guideline discusses the diagnosis and classification of these patients as high risk, as well as various treatment approaches, including external radiotherapy plus androgen deprivation therapy, radical prostatectomy with extended lymphadenectomy, external radiotherapy plus brachytherapy, hormone therapy, observation, and chemotherapy. Primary outcomes of interest include reductions in morbidity, cancer progression, recurrence, and mortality.

This is a clinical practice guideline for patients who have received treatment for prostate cancer. The guideline examines the various imaging modalities that can be effectively used for the follow-up of these patients. Variations of imaging modalities such as transrectal ultrasound (TRUS), magnetic resonance imaging (MRI), and computed tomography (CT) are discussed, and the appropriateness of different techniques is examined for different clinical situations.

This is a clinical practice guideline for patients with castration-resistant prostate cancer (CRPC). The guideline examines treatment options for six index patients that represent the most common clinical scenarios. Recommendations are based on the presence or absence of metastatic disease, the degree of symptoms, the patient's performance status, and whether or not their has been prior treatment with docetaxel-based chemotherapy. A scale for defining patient performance status is also provided.

This is a clinical practice guideline for patients who have been diagnosed with or are suspected of having advanced/metastatic prostate cancer. The guideline provides guidance on the staging, treatment, and follow up procedures for these patients. Topics of interest include radiotherapy techniques, the use of bone scans to assist in staging, and follow-up using active surveillance within a cancer clinic.

This is a clinical practice guideline developed for adult men who have elected to participate in an early prostate cancer detection program. The guideline provides a set of sequential recommendations detailing screening and evaluation strategies for maximizing the detection of prostate cancer that is effectively treatable and that, if left undetected, represents a risk to the patient. Several techniques designed to improve the identification of significant cancer, while avoiding the detection of indolent disease, are highlighted, including imaging, biomarker testing, and biopsy.

This is a clinical practice guideline for adult oncology patients with neutropenia. The guideline examines the appropriate prescribing of filgrastim for these patients. Indications for which filgrastim should be used are discussed by disease site group. Disease site groups considered include breast, central nervous system, gastrointestinal, gynecologic, genitourinary, hematologic, and thoracic, amongst others.

This is a clinical practice guideline for patients with prostate cancer. The guideline examines various treatment options including active surveillance, radical prostatectomy, radiation therapy, other local therapies, androgen deprivation therapy, chemotherapy, and immunotherapy. It also discusses risk stratification, imaging, and estimates of life expectancy. Recommendations are provided for the initial diagnosis, clinical assessment, and staging evaluation, as well as for treatment, which are based on both the level of risk, and specific disease present.

This is a clinical practice guideline for men with localized prostate cancer. The guideline provides recommendations on the use of moderate hypofractionated and ultrahypofractionated external beam radiation therapy (EBRT), with particular reference to oncologic outcomes, toxicity, and quality of life.

This is a clinical practice guideline for adult men who are at average risk of developing prostate cancer. The guideline examines screening methods for the early detection of prostate cancer for the purpose of reducing mortality. Outcomes of interest include prostate cancer incidence, mortality, quality of life, and the diagnostic performance of each of the tests, including the harms of testing (premature death and complications from both testing and biopsy).

This is a clinical practice guideline for adult men with a suspicion or recent diagnosis of localized prostate cancer. The guideline examines staging, treatment options, and follow-up for these patients. Management is discussed for low, intermediate, and high-risk disease. Treatment options considered include variations of radical prostatectomy, brachytherapy, external beam radiotherapy, cryosurgery, and active surveillance.

This is a clinical practice guideline for patients with prostate cancer. The guideline examines various treatment options including active surveillance, radical prostatectomy, radiation therapy, other local therapies, androgen deprivation therapy, chemotherapy, and immunotherapy. It also discusses risk stratification, imaging, and estimates of life expectancy. Recommendations are provided for the initial diagnosis, clinical assessment, and staging evaluation, as well as for treatment, which are based on both the level of risk, and specific disease present.

This is a clinical practice guideline for men with metastatic non-castrate prostate cancer being considered for treatment with androgen-deprivation therapy (ADT). The guideline examines the addition of docetaxel or abiraterone to ADT, and the resulting effects on overall survival (OS), progression-free survival (PFS), failure-free survival (FFS), prostate-specific antigen (PSA) response, overall response rate, and quality of life (QOL).

This is a clinical practice guideline for asymptomatic men. The guideline discusses the appropriateness of periodic prostate-specific antigen (PSA) based screening for prostate cancer. Recommendations for screening are separated based on patient age.

This is a clinical practice guideline for men and adolescents with hematospermia or hemospermia. The guideline discusses imaging techniques such as transrectal ultrasound (TRUS) and magnetic resonance imaging (MRI), and their use in the identification of hematospermia's etiology. The guideline examines the appropriateness of different imaging techniques based on patient age, severity of bleeding, and presence of other relevant symptoms.

This is a clinical practice guideline for the management of localized prostate cancer. The guideline provides a clinical framework stratified by cancer severity to guide the care plan and reviews management options including active surveillance, observation/watchful waiting, prostatectomy, radiotherapy, cryosurgery, high intensity focused ultrasound (HIFU), and focal therapy. Shared decision making is highlighted, and guidance is provided on outcome expectations and management.

This is a provisional clinical opinion (PCO) for chemotherapy-naive men with castration-resistant prostate cancer (CRPC). This PCO examines second-line hormonal therapy and provides recommendations on staging, treatment, follow-up, and palliative care for men with CRPC. Outcomes of interest include overall survival, adverse events, quality of life, and treatment efficacy (defined as response in prostate-specific antigen values).

This is a clinical practice guideline for patients with metastatic prostate cancer (mPCa). The guideline examines the management of patients with castration-naïve mPCa and those with metastatic castration-resistant prostate cancer (mCRPC). The use of predictive markers in mCRPC, sequencing treatment in mCRPC, managing men with oligometastases, as well as the staging and monitoring of mCRPC treatment, are also discussed.

This guideline provides recommendations on use of vertebroplasty or kyphoplasty as treatment options for cancer patients with vertebral compression fractures. The guideline outlines clinical criteria for when vertebroplasty, kyphoplasty, or focal tumour ablation (FTA) assisted vertebroplasty/kyphoplasty should be performed, and provides recommendations on selecting the most appropriate procedure. The role of radiation treatment, absolute contraindications, and service provider requirements are also discussed.

This is a clinical practice guideline for adult males with potentially curable prostate cancer. The guideline examines surgical procedures and outcomes for radical prostatectomy (RP), while specifically addressing the extent of resection, acceptable positive margins, nerve-sparing techniques, pelvic lymph node dissection (PLND), and the recommended procedures for handling and processing RP specimens. Incontinence, erectile dysfunction, rectal injury, and blood transfusion are discussed as surgical complications that need to be limited.

This is a clinical practice guideline for asymptomatic Canadian men. The guideline provides recommendations on the current best practices for prostate cancer screening and early diagnosis, and provides information on new and emerging diagnostic modalities.

This recommendation report addresses "best practices" for prostate needle biopsies. Guidance is provided on the spectrum of prostate needle biopsy practices, including patient preparation, biopsy techniques, specimen submission to the laboratory, processing of the biopsy specimen, information to include on the requisition and pathology report, and operational issues. Facility requirements are also reviewed.

This is a clinical practice guideline for patients with newly diagnosed prostate cancer who require or choose active treatment, and are not receiving active surveillance by choice or lack of suitability. The guideline examines the efficacy of brachytherapy, as compared to and combined with external beam radiation therapy (EBRT) and radical prostatectomy (RP). The guideline also considers which isotopes should be used for low-dose rate (LDR) brachytherapy to maximize clinical outcomes.

This is a clinical practice guideline for adult men with prostate cancer or clinically suspected prostate cancer. The guideline examines the various imaging modalities that can be effectively used to manage these patients, during initial diagnosis, staging, and active surveillance. Variations of imaging modalities such as transrectal ultrasound (TRUS), magnetic resonance imaging (MRI), and computed tomography (CT) are discussed, and the appropriateness of different techniques is examined for different clinical situations.

This is a clinical practice guideline for adult patients with prostate cancer. The guideline examines the screening, diagnosis, staging, treatment, and follow-up of these patients. Treatment options considered include deferred treatment, radical prostatectomy, definitive radiotherapy, and hormonal therapy. Management of metastatic prostate cancer, prostate cancer in older men, prostate-specific antigen-only recurrence after treatment, and castration-resistant prostate cancer are also discussed, as well as the epidemiology and etiology of prostate cancer, and quality of life outcomes.

This is a clinical practice guideline on the diagnosis of prostate cancer. The guideline examines effective diagnostic methods and provides recommendations on testing and referrals. Outcomes of interest include diagnostic accuracy, sensitivity, and specificity. Other topics of discussion include factors associated with delayed referral and risk factors that are predictive of prostate cancer.

This is a clinical practice guideline for the use of myeloid growth factors in adult patients with solid tumours and non-myeloid malignancies. Benefits and risks are reviewed, the role of biosimilars is discussed, and recommendations are provided for prophylactic and therapeutic uses of both granulocyte and granulocyte-macrophage colony stimulating factors (CSFs). Recommendations are also given regarding the use of CSFs in the hematopoietic cell transplant setting. Outcomes of interest include efficacy of CSFs, mortality, length of hospitalization, toxicity, and adverse effects.

This clinical practice guideline reviews diagnostic assessment and management of prostate cancer. The guideline discusses risk stratification, molecular testing, and imaging for clinical assessment and staging workup. Management options reviewed include observation, active surveillance, radical prostatectomy, radiation therapy, androgen deprivation therapy, chemotherapy, and immunotherapy, with treatment recommendations stratified by risk. Outcomes of interest include survival and adverse effects of treatment.

This is a clinical practice guideline for magnetic resonance imaging (MRI) for pre-treatment local staging of prostate cancer. The use of MRI for pre-treatment local staging is juxtaposed with the ways in which prostate cancer is conventionally detected which includes prostate-specific antigen (PSA) screening, digital rectal examination (DRE), and biopsy-confirmed diagnosis by transrectal ultrasonography (TRUS). The guideline therefore explores the performance and diagnostic accuracy of MRI, as well as the impact of pre-treatment local staging by MRI on patient on patient outcomes, biochemical recurrence, changes in treatment planning (including nerve- sparing surgery), changes in stage classification, and surgical margin status in men with newly diagnosed biopsy-confirmed prostate cancer who are under consideration for radical treatment.

A clinical practice guideline for middle-aged and older men at risk for prostate cancer who are considering, or have decided to have, a PSA test. The guideline examines supporting informed decision making for PSA testing, recommended protocols, and diagnosis and management for abnormal results. Outcomes of interest include reducing over-diagnosis and improved cumulative mortality.

A clinical practice guideline for patients with prostate cancer. The guideline examines permanent source brachytherapy in low and high risk patients combined with external-beam radiation therapy and/or androgen deprivation therapy. Outcomes of interest include quality of life, quality of life, complication rates, and biochemical outcomes.

A clinical practice guideline for adults with locally advanced, high-risk prostate cancer. The guideline examines aggressive approaches to prostate cancer treatment, focusing on intensive local therapy through external beam radiation. Outcomes of interest include improved local control resulting in improved outcomes via combination therapy.

This is a clinical practice guideline for palliative oncology patients 18 years of age or older with low grade/ low volume/ malignancy-associated urogenital or gastrointestinal bleeding, or with malignant gastrointestinal obstruction, compression or invasion. External beam radiotherapy (EBRT) with or without , brachytherapy, stent placement, and surgical bypass are discussed as therapeutic options. Outcomes of interest include clinical improvement of symptoms, quality of life, and survival.

A clinical practice guideline for patients with localized prostate cancer undergoing external beam radiation. The guideline examines treatment planning and delivery, with specific intervention details for multiple clinical variants. Outcomes of interest include improved clinical outcomes and reduced GI toxicity.

This is a clinical practice guideline for patients with prostate cancer. The guideline provides recommendations on the use of immunotherapy for the treatment of these patients, with recommendations separated based on the stage of disease (i.e. whether metastatic or non-metastatic, castration-sensitive or castration-resistant). Specific topics discussed include issues related to patient selection, monitoring of patients during and after treatment, and sequence/combination with other anti-cancer treatments.

This is a clinical practice guideline for men with prostate cancer who are receiving androgen deprivation therapy (ADT). The guideline examines the effectiveness of therapies that target bone, which can mitigate the effects of ADT on bone health. Outcomes of interest include fracture, bone mineral density (BMD), osteoporosis, skeletal-related events (SREs), bone metastasis, pain, patient-reported quality of life (QOL), and overall survival.

This is a clinical practice guideline for healthy male patients who have elected to participate in early screening of prostate cancer. The guideline reviews types of early detection testing, mainly PSA and DRE, provides recommendations on baseline evaluation, risk assessment, and early detection evaluation, provides guidance on indications for biopsy and direction for management of biopsy results. Special topics of interest include biomarker testing and biopsy technique.

This is a clinical practice guideline for male patients diagnosed with or suspected of having prostate cancer. The guideline reviews classification and staging, diagnostic evaluation, disease management, and follow-up care. Side effects of local treatment and health-related quality of life in prostate cancer survivors are also discussed. Outcomes of interest include overall survival, cancer-specific survival, development of metastatic disease, sensitivity and specificity of diagnostic procedures, and side effects of treatment.