American Society of Clinical Oncology recommendations for the initial hormonal management of androgen-sensitive metastatic, recurrent, or progressive prostate cancer.
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.
Loblaw
D Andrew
DA
Cancer Policy and Clinical Affairs, 1900 Duke St, Suite 200, Alexandria, VA 22314, USA. guidelines@asco.org
Mendelson
David S
DS
Talcott
James A
JA
Virgo
Katherine S
KS
Somerfield
Mark R
MR
Ben-Josef
Edgar
E
Middleton
Richard
R
Porterfield
Henry
H
Sharp
Stewart A
SA
Smith
Thomas J
TJ
Taplin
Mary Ellen
ME
Vogelzang
Nicholas J
NJ
Wade
James L
JL
Bennett
Charles L
CL
Scher
Howard I
HI
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
D018931:Antineoplastic Agents, Hormonal; D011944:Receptors, Androgen