title: Non-metastatic castrate-resistant prostate cancer: a call for improved guidance on clinical management.
abstract: BACKGROUND
  Guidelines on the clinical management of non-metastatic castrate-resistant prostate cancer (nmCRPC) generally focus on the need to continue androgen deprivation therapy and enrol patients into clinical trials of investigational agents. This guidance reflects the lack of clinical trial data with established agents in the nmCRPC patient population and the need for trials of new agents.
  
  
  OBJECTIVE
  To review the evidence base and consider ways of improving the management of nmCRPC.
  
  
  CONCLUSIONS
  Upon the development of castrate resistance, it is essential to rule out the presence of metastases or micrometastases by optimising the use of bone scans and possibly newer procedures and techniques. When nmCRPC is established, management decisions should be individualised according to risk, but risk stratification in this diverse population is poorly defined. Currently, prostate-specific antigen (PSA) levels and PSA doubling time remain the best method of assessing the risk of progression and response to treatment in nmCRPC. However, optimising imaging protocols can also help assess the changing metastatic burden in patients with CRPC. Clinical trials of novel agents in nmCRPC are limited and have problems with enrolment, and therefore, improved risk stratification and imaging may be crucial to the improved management. The statements presented in this paper, reflecting the views of the authors, provide a discussion of the most recent evidence in nmCRPC and provide some advice on how to ensure these patients receive the best management available. However, there is an urgent need for more data on the management of nmCRPC.
authors.affiliation: Department of Urology, L'Institut Mutualiste Montsouris, 42 Boulevard Jourdan, 75014, Paris, France. francois.rozet@imm.fr.
authors.forename: Francois
authors.initials: F
authors.lastname: Rozet
authors.affiliation: Department of Urology, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium.
authors.forename: Thierry
authors.initials: T
authors.lastname: Roumeguère
authors.affiliation: Department of Urology, Bern University Hospital, Bern, Switzerland.
authors.forename: Martin
authors.initials: M
authors.lastname: Spahn
authors.affiliation: Clinic for Diagnostic and Interventional Radiology, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Dirk
authors.initials: D
authors.lastname: Beyersdorff
authors.affiliation: Department of Urology, Academic Hospital Braunschweig, Braunschweig, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Hammerer
mesh_terms: D000726:Androgen Antagonists / Q000627:therapeutic use; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use*; D003952:Diagnostic Imaging; D019468:Disease Management; D018450:Disease Progression; D006801:Humans; D008297:Male; D017430:Prostate-Specific Antigen / Q000097:blood; D064129:Prostatic Neoplasms, Castration-Resistant / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy
chemical_list: D000726:Androgen Antagonists; D018931:Antineoplastic Agents, Hormonal; D017430:Prostate-Specific Antigen
keywords: Imaging; Individualised management; Management; Non-metastatic castrate-resistant prostate cancer