title: EAU guidelines on prostate cancer. Part II: Treatment of advanced, relapsing, and castration-resistant prostate cancer.
abstract: OBJECTIVE
  Our aim is to present a summary of the 2010 version of the European Association of Urology (EAU) guidelines on the treatment of advanced, relapsing, and castration-resistant prostate cancer (CRPC).
  
  
  METHODS
  The working panel performed a literature review of the new data emerging from 2007 to 2010. The guidelines were updated, and the levels of evidence (LEs) and/or grades of recommendation (GR) were added to the text based on a systematic review of the literature, which included a search of online databases and bibliographic reviews.
  
  
  RESULTS
  Luteinising hormone-releasing hormone (LHRH) agonists are the standard of care in metastatic prostate cancer (PCa). Although LHRH antagonists decrease testosterone without any testosterone surge, their clinical benefit remains to be determined. Complete androgen blockade has a small survival benefit of about 5%. Intermittent androgen deprivation (IAD) results in equivalent oncologic efficacy when compared with continuous androgen-deprivation therapy (ADT) in well-selected populations. In locally advanced and metastatic PCa, early ADT does not result in a significant survival advantage when compared with delayed ADT. Relapse after local therapy is defined by prostate-specific antigen (PSA) values >0.2 ng/ml following radical prostatectomy (RP) and >2 ng/ml above the nadir after radiation therapy (RT). Therapy for PSA relapse after RP includes salvage RT at PSA levels <0.5 ng/ml and salvage RP or cryosurgical ablation of the prostate in radiation failures. Endorectal magnetic resonance imaging and (11)C-choline positron emission tomography/computed tomography (CT) are of limited importance if the PSA is <2.5 ng/ml; bone scans and CT can be omitted unless PSA is >20 ng/ml. Follow-up after ADT should include screening for the metabolic syndrome and an analysis of PSA and testosterone levels. Treatment of castration-resistant prostate cancer (CRPC) includes second-line hormonal therapy, novel agents, and chemotherapy with docetaxel at 75 mg/m(2) every 3 wk. Cabazitaxel as a second-line therapy for relapse after docetaxel might become a future option. Zoledronic acid and denusomab can be used in men with CRPC and osseous metastases to prevent skeletal-related complications.
  
  
  CONCLUSIONS
  The knowledge in the field of advanced, metastatic, and CRPC is rapidly changing. These EAU guidelines on PCa summarise the most recent findings and put them into clinical practice. A full version is available at the EAU office or online at www.uroweb.org.
authors.affiliation: Department of Urology, Clinique Mutualiste de la Loire, Saint Etienne, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Mottet
authors.forename: Joaquim
authors.initials: J
authors.lastname: Bellmunt
authors.forename: Michel
authors.initials: M
authors.lastname: Bolla
authors.forename: Steven
authors.initials: S
authors.lastname: Joniau
authors.forename: Malcolm
authors.initials: M
authors.lastname: Mason
authors.forename: Vsevolod
authors.initials: V
authors.lastname: Matveev
authors.forename: Hans-Peter
authors.initials: HP
authors.lastname: Schmid
authors.forename: Theo
authors.initials: T
authors.lastname: Van der Kwast
authors.forename: Thomas
authors.initials: T
authors.lastname: Wiegel
authors.forename: Filiberto
authors.initials: F
authors.lastname: Zattoni
authors.forename: Axel
authors.initials: A
authors.lastname: Heidenreich
mesh_terms: D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D000970:Antineoplastic Agents / Q000627:therapeutic use; D003131:Combined Modality Therapy; D000069448:Denosumab; D006801:Humans; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery; D009919:Orchiectomy; D017410:Practice Guidelines as Topic; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000601:surgery* / Q000628:therapy*; D053245:RANK Ligand; D011878:Radiotherapy
chemical_list: D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D000970:Antineoplastic Agents; D053245:RANK Ligand; D000069448:Denosumab