At the end of the peer review process, a total of 522 comments were received. The “medium risk of bias” category is broad, and studies with this rating vary in their strengths and weaknesses.
Clinicians should not offer oral androgen pathway directed therapy (e.g., abiraterone acetate plus prednisone, apalutamide, bicalutamide, darolutomide, enzalutamide, flutamide, nilutamide) without ADT for patients with mHSPC. Some patients might prefer a limited 18-week course of docetaxel to daily oral therapy for years. In mCRPC patients who are asymptomatic or minimally symptomatic, clinicians may offer sipuleucel-T. (Conditional Recommendation; Evidence Level: Grade B)29.
All peer review comments were blinded and sent to the Panel for review. Clinicians should not offer systemic chemotherapy or immunotherapy to nmCRPC patients outside the context of a clinical trial. (Clinical Principle)Prostate cancer patients frequently have comorbid conditions that may impact life expectancy as well as the ability to tolerate prostate cancer-directed therapies. (Expert Opinion)19. Finally, the landscape of evidence detailing the interactions between mutations and treatment individualization continues to evolve, and the use of genetic testing may ultimately enable the treating clinician to offer a personalized approach to prostate cancer treatment.27. 1. We also excluded in vitro and animal studies. In advanced prostate cancer patients at high fracture risk due to bone loss, clinicians should recommend preventative treatments with bisphosphonates or denosumab and referral to physicians who have familiarity with the management of osteoporosis when appropriate. There is no set interval for imaging of men with mHSPC, but imaging can demonstrate progression in the absence of PSA changes or in the absence of symptoms and should be considered as a method of evaluation of these patients. Fatigue was more common in the enzalutamide group, and seizures occurred in 7 patients in the enzalutamide group (1%) compared to 0 patients in the standard care group. However, it is clear that despite castrate levels of androgens, the androgen receptor (AR) remains active and continues to drive prostate cancer progression in most cancers. To present a summary of the 2007 version of the European Association of Urology (EAU) guidelines on prostate cancer (PCa). Further, no trials have found a benefit for using both docetaxel and enzalutamide/apalutamide as of yet, though ongoing trials will more directly address this. Clinicians are challenged to remain up-to-date and informed with respect to a multitude of treatment options for patients with advanced prostate cancer. Progression in non-bone sites is not infrequent during this six-month period of treatment.
It can include controlling symptoms that are physical, psychological, spiritual, and social. (Clinical Principle)There are established laboratory and imaging characteristics known to be associated with prognosis among men with mCRPC. Currently Given the ability to identify metastatic sites earlier than was previously possible, there has been renewed interest in the concept of MDT with radiation, surgery, or ablative technologies. However, if ADT is initiated in the absence of metastatic disease, intermittent ADT may be offered in lieu of continuous ADT. (Strong Recommendation; Evidence Level: Grade B)Radium-223 is an α-emitting radiopharmaceutical capable of inducing double strand DNA breaks in cancer cells while minimizing exposure to surrounding marrow. Landmark studies by Tannock et al. For cohort studies on prognostic factors, criteria included methods for assembling cohorts, attrition, blinding assessment of outcomes, and adjustment for potential confounding.The methodology team assessed systematic reviews using AMSTAR 2 (Assessing the Methodological Quality of Systematic Reviews) criteria. In mCRPC patients, clinicians should assess the extent of metastatic disease using conventional imaging at least annually or at intervals determined by lack of response to therapy. (Strong Recommendation; Evidence Level: Grade B)30. Given the lack of utility of PSA measurement in this space, the Panel recommends consideration to obtain abdomen/pelvis CT imaging and chest x-ray even in the absence of symptoms prior to cycle 4 (of planned 6 monthly cycles) to assess for occult disease progression.Clinicians should also be advised against concurrent use of abiraterone acetate plus prednisone in combination with radium-223 given the association with a higher risk of skeletal related events.30.
The past decade has witnessed a true paradigm change for the management of prostate cancer: after many years of refractory, pervasive overtreatment in the USA and elsewhere, active surveillance evolved rapidly from a primarily academic endeavor to the preferred standard of care for low-risk disease, endorsed by multiple international guidelines [1–3]. While emphasising evidence-based medicine, interactive breakout sessions will explore difficulties in diagnosis, the use of imaging tools, and effective follow-up strategies. Clinicians should assess nmCRPC patients for development of metastatic disease using conventional imaging at intervals of 6 to 12 months. ASCO 2020: Short-Term Adjuvant Versus Neoadjuvant Hormone Therapy in Localized Prostate Cancer: A Pooled Individual Patient Analysis of Two Phase III Trials ASCO 2020: CYCLONE 2: A Phase II, Randomized, Placebo-Controlled Study of Abiraterone Acetate plus Prednisone with or Without Abemaciclib in Patients with Metastatic Castration-Resistant Prostate Cancer
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