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ASCO revises prostate cancer guidelines
The new guidelines recommend that clinical trials be considered for patients with recurrent prostate cancer.
The American Society of Clinical Oncology has made revisions to its 2004 clinical practice guideline for initial management of androgen-sensitive, metastatic, recurrent or progressive prostate cancer.
The guideline update, published in the Journal of Clinical Oncology, addressed whether early androgen deprivation therapy is beneficial for patients with metastatic or progressive prostate cancer, compared with deferring therapy.
The new guideline recommends either bilateral orchiectomy or luteinizing hormone-releasing hormones as initial androgen deprivation therapy treatments. Combined androgen blockade should be considered in the treatment of locally advanced or metastatic prostate cancer, which uses nonsteroidal antiandrogen therapy with an orchiectomy or luteinizing hormone-releasing hormones to treat prostate cancer. The guideline recommends that clinical trials be considered for patients with recurrent prostate cancer.
The ASCO panel found a 17% decrease in mortality from prostate cancer and a 15% increase in mortality from other causes, which indicates no overall survival advantage associated with androgen deprivation therapy.
“There is debate in the medical community regarding optimal timing for starting androgen deprivation therapy for prostate cancer,” Andrew Loblaw, MD, radiation oncologist at Toronto-Sunnybrook Regional Cancer Center, said in a press release. “Doctors should discuss with patients the risks and benefits of early deprivation therapy vs. deferred therapy. If the patient prefers to defer therapy, he should have regular visits with his doctor every three to six months to monitor the disease.”
Advocates for deferred therapy believe that many men with prostate cancer die of other causes, rather than of the disease itself. They also believe that the adverse effects of androgen deprivation therapy can outweigh their clinical benefits. Adverse effects of androgen deprivation therapy include depression, loss of sexual desire, hot flashes, enlarged breasts, weight gain, fatigue, osteoporosis and high cholesterol.
Androgen deprivation therapy is used to slow the growth of hormone-dependent prostate cancer cells by blocking the negative effect of testosterone and other male hormones. Current data are insufficient to support the use of intermittent androgen blockade outside of clinical trials. Intermittent androgen blockade is hormone therapy given for specified periods and then stopped temporarily according to schedule. This therapy is used to prevent prostate cancer from growing without hormones.
“Overall, survival for men with prostate cancer is greater with the combination of nonsteroidal antiandrogen therapy and surgical or medical castration, over one of these treatments alone, though patients may experience increased side effects due to combined therapies, depending on the nonsteroidal agent used,” Loblaw said.
Doctors can begin administering androgen deprivation therapy after a patient’s tests show recurrence or progression of prostate cancer or they can defer therapy. Most often a patient will have no symptoms of prostate cancer at the time.
However, all patients should start androgen deprivation therapy after they experience symptoms.
For more information:
- Loblaw DA, Virgo KS, Nam R, et al. Initial hormonal management of androgen-sensitive metastatic, recurrent, or progressive prostate cancer: 2006 update of an American Society of Clinical Oncology Practice guideline. J Clin Oncol. 2007; 25:1:1596-1605.