Prostate Cancer
Spanish Society of Medical Oncology and the Spanish Genitourinary Oncology Group
In PSA recurrence, M0 disease, after radical prostatectomy (RP), salvage radical radiotherapy (RT) is an option. Standard work-up in this setting is a bone scan if the patient has a higher than 10 ng/ml baseline PSA or symptomatic bone disease, and choline-PET only if PSA ≥1 ng/ml.
If primary treatment was RT, then salvage RP, cryotherapy, or brachytherapy may be indicated in selected patients.
Androgen deprivation therapy (ADT) or intermittent ADT are options in patients treated with RT.
Surgical castration, luteinizing-hormone releasing hormone (LHRH) agonist or antagonist is standard of care for ADT.
Abiraterone plus ADT is recommended in mHSPC (metastatic hormone-sensitive prostate cancer) patients.
LHRH analogues should be continued in patients with CRPC (castration-resistant prostate cancer).
Sipuleucel-T [approved in the US for treatment of asymptomatic or minimally symptomatic metastatic castrate-resistant (hormone refractory) prostate cancer] would be a treatment option in asymptomatic patients with mCRPC if regulatory approval is obtained in Europe.
Abiraterone is a treatment option for asymptomatic or minimally symptomatic patients with mCRPC without visceral metastases and previously untreated with chemotherapy.
Enzalutamide is a treatment option for asymptomatic and minimally symptomatic patients with mCRPC, including selected patients with visceral metastases who have not received previous chemotherapy.
Patients with asymptomatic or minimally symptomatic mCRPC and adverse prognostic factors (the presence of visceral metastases) should also be considered for docetaxel treatment.
Docetaxel at 75 mg/m2 every 21 days plus prednisone 5 mg bid is the preferred first-line treatment for symptomatic mCRPC naive for docetaxel.
Docetaxel at 50 mg/m2 every 15 days may be considered as a potentially less toxic alternative.
Ra-223 at 55 mBq/kg every 28 days for 6 cycles could be offered to mCRPC patients naive for docetaxel who have symptomatic bone metastases and no known visceral metastases who are unfit or are not willing to receive docetaxel.
Abiraterone or enzalutamide could be considered as an alternative first-line treatment for symptomatic mCRPC patients naive for docetaxel who are unfit or unwilling to receive docetaxel.
Zoledronic acid and denosumab are effective systemic therapies in preventing and delaying cancer-related skeletal events in CRPC.
Zoledronic acid is not indicated in non-CRPC.
Denosumab is superior to zoledronic acid for delaying skeletal-related events in CRPC.
Reference
Cassinello J, Arranz JA, Piulats et al. SEOM Clinical Guidelines for the Treatment of Metastatic Prostate Cancer (2017). Clin Transl Oncol. 2017 Nov 13. https://link.springer.com/article/10.1007%2Fs12094-017-1783-2
Medscape © 2017 WebMD, LLC
Any views expressed above are the author's own and do not necessarily reflect the views of WebMD or Medscape.
Cite this: John Anello, Brian Feinberg, John Heinegg, et. al. New Clinical Practice Guidelines, December 2017 - Medscape - Dec 06, 2017.
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