Clinically Localized Prostate Cancer

6. Clinicians should not perform abdominopelvic CT or routine bone scans in the staging of asymptomatic very low or low risk localized prostate cancer patients.

7. Clinicians should recommend active surveillance as the best available care option for very low risk localized prostate cancer patients.

8. Clinicians should recommend active surveillance as the preferable care option for most low risk localized prostate cancer patients.

9. Clinicians may offer definitive treatment (i.e. radical prostatectomy or radiotherapy) to select low risk localized prostate cancer patients who may have a high probability of progression on active surveillance.

10. Clinicians should not add androgen deprivation therapy (ADT) along with radiotherapy for low risk localized prostate cancer with the exception of reducing the size of the prostate for brachytherapy.

11. Clinicians should inform low risk prostate cancer patients considering whole gland cryosurgery that consequent side effects are considerable and survival benefit has not been shown in comparison to active surveillance.

12. Clinicians should inform low risk prostate cancer patients who are considering focal therapy or HIFU that these interventions are not standard care options because comparative outcome evidence is lacking.

13. Clinicians should recommend observation or watchful waiting for men with a life expectancy £5 years with low risk localized prostate cancer.

14. Among most low risk localized prostate cancer patients, tissue based genomic biomarkers have not shown a clear role in the selection of candidates for active surveillance.

15. Clinicians should consider staging unfavorable intermediate risk localized prostate cancer patients with cross-sectional imaging (CT or MRI) and bone scan.

16. Clinicians should recommend radical prostatectomy or radiotherapy plus ADT as standard treatment options for patients with intermediate risk localized prostate cancer.

17. Clinicians should inform patients that favorable intermediate risk prostate cancer can be treated with radiation alone, but the evidence basis is less robust than for combining radiotherapy with ADT.

18. In select patients with intermediate risk localized prostate cancer, clinicians may consider other treatment options such as cryosurgery.

19. Active surveillance may be offered to select patients with favorable intermediate risk localized prostate cancer. However, patients should be informed that this comes with a higher risk of developing metastases compared to definitive treatment.

20. Clinicians should recommend observation or watchful waiting for men with a life expectancy £5 years with intermediate risk localized prostate cancer.

21. Clinicians should inform intermediate risk prostate cancer patients who are considering focal therapy or HIFU that these interventions are not standard care options because comparative outcome evidence is lacking.

22. Clinicians should stage high risk localized prostate cancer patients with crosssectional imaging (CT or MRI) and bone scan.

23. Clinicians should recommend radical prostatectomy or radiotherapy plus ADT as standard treatment options for patients with high risk localized prostate cancer.

24. Clinicians should not recommend active surveillance for patients with high risk localized prostate cancer. Watchful waiting should only be considered in asymptomatic men with limited life expectancy (£5 years).

25. Cryosurgery, focal therapy, and HIFU treatments are not recommended for men with high-risk localized prostate cancer outside of a clinical trial.

26. Clinicians should not recommend primary ADT for patients with high risk localized prostate cancer unless the patient has both limited life expectancy and local symptoms.

27. Clinicians may consider referral for genetic counseling for patients (and their families) with high risk localized prostate cancer and a strong family history of specific cancers (e.g., breast, ovarian, pancreatic, other gastrointestinal tumors, lymphoma).