Prostate Cancer Coverage from Every Angle

Updated ESMO Guidelines for Management of Prostate Cancer

By: Julia Fiederlein
Posted: Monday, August 24, 2020

The European Society for Medical Oncology (ESMO) Guidelines Committee, a multidisciplinary group of experts from numerous institutions and countries in Europe, released updated clinical practice guidelines for the optimal management of patients with prostate cancer. Their recommendations were published in the Annals of Oncology.

According to the guidelines, early prostate-specific antigen (PSA) testing may be offered to men older than age 50, men older than age 45 with a family history of prostate cancer, Black men older than age 45, and BRCA1/2 carriers older than age 40. In terms of diagnosis, a multiparametric MRI should be completed prior to prostate biopsy. The committee recommended clinicians consider a transperineal biopsy rather than performing a transrectal ultrasound-guided biopsy.

Patients with high-risk or locally advanced disease should receive external-beam radiotherapy and androgen-deprivation therapy (ADT), and patients with low-risk disease should be offered active surveillance. Those with intermediate-risk disease or low-risk disease not suitable for active surveillance may undergo radical prostatectomy or radiotherapy. Primary ADT alone should not be administered as a standard initial treatment of nonmetastatic prostate cancer. Patients with hormone-naive metastatic prostate cancer may be offered ADT in combination with abiraterone plus prednisone, apalutamide, docetaxel, or enzalutamide; those who are deemed unfit for this treatment regimen should receive ADT alone. The committee advised that patients initiating long-term ADT be offered an oral bisphosphonate or be monitored with dual-energy x-ray absorptiometry.

Patients with nonmetastatic castration-resistant prostate cancer at high risk of disease progression should receive apalutamide, darolutamide, or enzalutamide. The committee recommended docetaxel for patients with metastatic castration-resistant prostate cancer. Those in the postdocetaxel setting may be offered abiraterone, enzalutamide, and cabazitaxel, the authors noted. Abiraterone or enzalutamide therapy is recommended for patients with asymptomatic or mildly symptomatic chemotherapy-naive metastatic castration-resistant prostate cancer. Clinicians should refer to the guidelines for management of specific cases.

Disclosure: For full disclosures of the committee, visit

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