I cannot provide you with a "PACE B protocol" for prostate cancer because no such standardized protocol exists in the medical literature or established guidelines 1, 2.
What You May Be Looking For
You may be confusing terminology or seeking information about risk stratification and treatment protocols for prostate cancer, which are well-established. Here's the current standard approach:
Risk-Based Treatment Algorithm
Risk Stratification (Required First Step)
Classification is based on three factors 2, 3:
- Low-risk: PSA ≤10 ng/mL AND Gleason score ≤6 AND clinical stage T1c-T2a 2, 3
- Intermediate-risk: PSA 10-20 ng/mL OR Gleason score 7 OR clinical stage T2b 2, 3
- High-risk: PSA >20 ng/mL OR Gleason score 8-10 OR clinical stage ≥T2c 2, 3
Treatment Selection by Risk Category
For Low-Risk Disease:
- Active surveillance is the preferred approach 2, 3
- This involves close monitoring with PSA measurements, repeat biopsies, and/or MRI, reserving curative treatment only for progression 2, 3
- Only 13% develop metastases at 15 years, making aggressive treatment unnecessary for most patients 3
For Intermediate-Risk Disease:
- Radical prostatectomy and external beam radiotherapy are equally effective options 2
- If choosing radiotherapy, add neoadjuvant and concurrent androgen deprivation therapy (ADT) for 4-6 months 2, 3
For High-Risk Disease:
- External beam radiotherapy (EBRT) plus ADT for 24-36 months is the standard approach 2, 3
- Radical prostatectomy plus pelvic lymphadenectomy is an alternative for fit patients 3
Critical Modifier: Life Expectancy
Curative treatment is generally not recommended when life expectancy is <10 years 2, 3. In these cases:
- Watchful waiting with delayed hormone therapy is appropriate 3
- This applies regardless of risk category 1
Staging Workup (Before Treatment Selection)
Required for all patients 1:
- Digital rectal examination and transrectal ultrasound 1
- At least 10-12 core biopsies with Gleason scoring 2
- PSA level 1
Additional staging for specific scenarios 1:
- Bone scan if: bone pain present, locally advanced tumor (≥T3), Gleason grade 4 or 5, or PSA ≥10 ng/mL 1
- Abdominal/pelvic CT scan if: stage ≥T2a, PSA >15 ng/mL, or Gleason score ≥7 1
- Renal ultrasound for stage T3 disease 1
Metastatic Disease Protocol
For metastatic hormone-naïve prostate cancer 2, 4:
- Continuous ADT (gonadotropin-releasing hormone agonists like goserelin) plus androgen receptor pathway inhibitors (abiraterone or darolutamide) 2, 5, 4
- Abiraterone improved median overall survival from 36.5 to 53.3 months compared to ADT alone 4
- Add docetaxel chemotherapy for patients fit enough to receive it, especially with extensive disease 2, 4, 6
Common Pitfalls
- Do not use the term "PACE B protocol" as it will cause confusion—no such protocol exists in prostate cancer management 1, 2
- Do not overtreat low-risk disease—active surveillance is safe and prevents unnecessary morbidity from surgery or radiation 2, 3
- Do not ignore life expectancy—curative treatment offers minimal benefit when life expectancy is <10 years 2, 3
- Do not delay salvage radiotherapy after prostatectomy—it is most effective when PSA is <0.5 ng/mL 2, 3
If you were referring to a specific institutional protocol or acronym used at your facility, please clarify, as it is not a recognized standard in prostate cancer management.