title: American Society of Clinical Oncology recommendations for the initial hormonal management of androgen-sensitive metastatic, recurrent, or progressive prostate cancer.
abstract: OBJECTIVE
  To develop a clinical practice guideline for the management of men with metastatic, recurrent, or progressive carcinoma of the prostate. The focus of this document is on the use, combinations, and timing of various forms of androgen deprivation therapy (ADT) for the palliation of men with androgen-sensitive disease.
  
  
  METHODS
  An expert panel and writing committee were formed. The questions to be addressed by the guideline were determined, and a systematic review of the literature was performed, which included a search of online databases, bibliographic review, and consultation with content experts. A priori criteria were used to select studies for analysis and study authors were contacted when necessary.
  
  
  RESULTS
  There were 10 randomized controlled trials, six systematic reviews, and one Markov model available to inform the guidelines.
  
  
  CONCLUSIONS
  A full discussion between practitioner and patient should occur to determine which therapy is best for the patient. Bilateral orchiectomy or luteinizing hormone releasing hormone agonists are the recommended initial treatments. Nonsteroidal antiandrogen therapy may be discussed as an alternative, but steroidal antiandrogens should not be offered as monotherapy. Patients willing to accept the increased toxicity of combined androgen blockage for a small benefit in survival should be offered nonsteroidal antiandrogen in addition to castrate therapy. Until data from studies using modern medical diagnostic/biochemical tests and standardized follow-up schedules become available, no specific recommendations can be issued regarding the question of early versus deferred ADT. A discussion about the pros and cons of early versus deferred ADT should occur.
authors.affiliation: Cancer Policy and Clinical Affairs, 1900 Duke St, Suite 200, Alexandria, VA 22314, USA. guidelines@asco.org
authors.forename: D Andrew
authors.initials: DA
authors.lastname: Loblaw
authors.forename: David S
authors.initials: DS
authors.lastname: Mendelson
authors.forename: James A
authors.initials: JA
authors.lastname: Talcott
authors.forename: Katherine S
authors.initials: KS
authors.lastname: Virgo
authors.forename: Mark R
authors.initials: MR
authors.lastname: Somerfield
authors.forename: Edgar
authors.initials: E
authors.lastname: Ben-Josef
authors.forename: Richard
authors.initials: R
authors.lastname: Middleton
authors.forename: Henry
authors.initials: H
authors.lastname: Porterfield
authors.forename: Stewart A
authors.initials: SA
authors.lastname: Sharp
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Smith
authors.forename: Mary Ellen
authors.initials: ME
authors.lastname: Taplin
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: Vogelzang
authors.forename: James L
authors.initials: JL
authors.lastname: Wade
authors.forename: Charles L
authors.initials: CL
authors.lastname: Bennett
authors.forename: Howard I
authors.initials: HI
authors.lastname: Scher
mesh_terms: D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D018450:Disease Progression; D006801:Humans; D008297:Male; D009362:Neoplasm Metastasis; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy*; D010166:Palliative Care; D011471:Prostatic Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000503:physiopathology; D011944:Receptors, Androgen
chemical_list: D018931:Antineoplastic Agents, Hormonal; D011944:Receptors, Androgen