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AUA Guideline Amendment for Castration-Resistant Prostate Cancer

By: Andrew Goldstein
Posted: Tuesday, January 8, 2019

Michael S. Cookson, MD, of the University of Oklahoma College of Medicine, and panel members published an amendment in late 2018 to the American Urological Association (AUA) guideline for castration-resistant prostate cancer in The Journal of Urology. Incorporating relevant data from 47 recent studies focusing on the management of patients with nonmetastatic castration-resistant prostate cancer, the guideline is intended to be used in conjunction with recent literature reviews as well as an understanding of the treatment goals of individual patients.

Here is a brief mention of the key recommendations in the 2018 amendment. The statements for Index Patients as well as those discussing bone health remain unchanged from the 2015 version of the guideline. For a full discussion of the AUA guideline amendment, see the link below.

  • Guideline Statement 1: Clinicians should offer apalutamide or enzalutamide with continued androgen deprivation to patients with nonmetastatic castration-resistant prostate cancer at high risk for developing metastatic disease (Standard; Evidence Level Grade A).
  • Guideline Statement 2: Clinicians may recommend observation with continued androgen deprivation to patients with non-metastatic castration-resistant prostate cancer at high risk for developing metastatic disease who do not want or cannot have one of the standard therapies (Recommendation; Evidence Level Grade C).
  • Guideline Statement 3: Clinicians may offer treatment with a second-generation androgen synthesis inhibitor (ie, abiraterone plus prednisone) to select patients with nonmetastatic castration-resistant prostate cancer at high risk for developing metastatic disease who do not want or cannot have one of the standard therapies and are unwilling to accept observation (Option; Evidence Level Grade C.)
  • Guideline Statement 3: Clinicians should not offer systemic chemotherapy or immunotherapy to patients with non-metastatic castration-resistant prostate cancer outside the context of a clinical trial (Recommendation; Evidence Level Grade C).

Disclosure: Panel members’ disclosures can be found at jurology.com.



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