Prostate cancer

New Guidelines to Treat Advanced Prostate Cancer

All patients with metastatic castration-resistant prostate cancer (mCRPC) should receive androgen-deprivation therapy (ADT) indefinitely, regardless of other treatments, according to a new guideline released by the American Society of Clinical Oncology and Cancer Care Ontario. 

Along with ADT, patients should be treated with abiraterone plus prednisone, enzalutamide, and radium-223, or docetaxel plus prednisone. 
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These recommendations come in response to a growing consideration of the quality of life in patients with mCRP.

“It is the opinion of the panel that the goal of treatment is to provide the best possible quality of life for as long as possible. Over the past decade, multiple therapies have become available for metastatic CRPC that provide OS benefit.”

The guidelines offer situations in which each specific drug combination should be used, including:

  • If chemotherapy is considered, docetaxel/prednisone should be offered and accompanied by a discussion of toxicity.
  • If disease progresses on docetaxel, clinicians may offer cabazitaxel (Jevtana), the side effects of which should also be discussed thoroughly.
  • Mitoxantrone may be offered with patient understanding of the therapy's limited clinical benefit and risk of side effects.
  • Clinicians may offer ketoconazole or antiandrogens but should clearly inform patients about expectations of limited clinical benefit and a risk of side effects.

The guidelines also caution against giving mCRPC patients bevacizumab, estramustine, and sunitinib. 

“In the contemporary selection of treatments, attention should be given to clinically meaningful benefit, risk of harm, quality of evidence, and cost when assisting patients with treatment decisions,” researchers concluded.

The full guidelines were published in the Journal of Clinical Oncology.

Reference:

Basch E, Loblam A, Oliver TK, et al. Systemic therapy in men with metastatic castration-resistant prostate cancer: American society of clinical oncology and cancer care Ontario clinical practice guideline. J Clin Oncol. 2014 September 8. [epub ahead of print]. http://jco.ascopubs.org/content/early/2014/09/03/JCO.2013.54.8404. Accessed September 9, 2014.