Updated AUA, ASTRO, and SUO Guideline for Management of Advanced Prostate Cancer
Posted: Thursday, July 23, 2020
The American Urological Association (AUA), American Society of Radiation Oncology (ASTRO), and Society of Urologic Oncology (SUO) released a joint guideline for the optimal management of patients with advanced prostate cancer. The systematic review, which was published by the AUA, provides suggestions to effectively diagnose and treat these patients while maintaining a high standard of care.
“The prostate cancer landscape has been rapidly evolving due to changes in prostate-specific antigen screening standards, as well as the approval of new classes of treatment options,” William Lowrance, MD, MPH, Chair of the Guideline Panel, stated in an AUA press release. “This guideline is comprised of clinical recommendations based on this new evidence and aims to further support the medical community and patients as they navigate through the various stages of this disease.”
Patients with suspected advanced prostate cancer should receive histologic diagnosis from the primary tumor or site of metastases. The panel recommends that patients receiving androgen-deprivation therapy (ADT) be informed of the risk of osteoporosis and offered preventative treatment.
Patients who have biochemical recurrence without metastasis after exhaustion of local treatment options should be offered observation or clinical trial enrollment. Although ADT is not recommended in this population, intermittent ADT may be offered in lieu of continuous ADT. Patients with metastatic hormone-sensitive disease should be offered ADT with luteinizing hormone–releasing hormone therapy or castration. First-generation antiandrogens in combination with luteinizing hormone–releasing hormone agonists and oral androgen pathway–directed therapy without ADT were not recommended.
The panel strongly advised offering apalutamide, darolutamide, or enzalutamide with continued ADT to patients with nonmetastatic castration-resistant disease at high risk of metastasis. Chemotherapy and immunotherapy were not recommended for this patient population. Patients with metastatic castration-resistant prostate cancer may be offered continued ADT with abiraterone acetate plus prednisone, docetaxel, or enzalutamide; however, clinicians should consult the guidelines for management of specific cases.
Disclosure: For full disclosures of the guideline panel, visit www.auanet.org.
