Advanced Prostate Cancer: AUA/ASTRO/SUO Guideline PART I

Abstract

The summary presented herein represents Part I of the two-part series dedicated to Advanced Prostate Cancer: AUA/ASTRO/SUO Guideline discussing prognostic and treatment recommendations for patients with biochemical recurrence without metastatic disease after exhaustion of local treatment options as well as those with metastatic hormone-sensitive prostate cancer. Please refer to Part II for discussion of the management of castration-resistant disease.

Treatment Strategies for Metastatic Castration-Sensitive Prostate Cancer: From “All-Comers” to “Personalized” Approach

“…Thus, recent clinical guidelines recommend a combination of docetaxel or ARPIs with ADT as first-line therapy for all patients with mCSPC. 13 , 14 The era of ADT alone may end and upfront combination therapies are becoming a standard of care as the initial treatment for “all-comers” with mCSPC.…”

“… 9–12 Thus, upfront combination therapies are becoming the first-line standard of care for “all-comers” as per the recommendations of recent clinical guidelines. 13 , 14 This direction may go against the recent general trend of cancer treatment because cancer treatment is advancing from the “all-comers” approach to the “individualized” and “precision” medicine approach.…”

Incorporating palliative care principles to improve patient care and quality of life in urologic oncology

“…However, guidelines released by national societies increasingly reflect the importance of symptom management and quality of life. For example, in 2020, joint guidelines from the American Urological Association (AUA), American Society for Radiation Oncology and Society for Urologic Oncology for management of patients with advanced prostate cancer specifically emphasized the need to prioritize pain control and connect men with palliative care resources in their community 92 . In 2014, the European Association of Urology (EAU) provided guidelines for the treatment of disease-specific pain, postoperative pain management and basic palliative care for symptoms such as dyspnoea, nausea and vomiting, anorexia and cachexia, and mood disorders 93,94 .…”

Incorporating PSMA-Targeting Theranostics Into Personalized Prostate Cancer Treatment: a Multidisciplinary Perspective

“…Biochemical recurrence after radical prostatectomy or primary radiation can potentially be cured with localized salvage therapy such as pelvic-targeted radiation or salvage prostatectomy ( 49 ). Biochemical recurrence can now be detected at earlier PSA values, with the definition of failure at 0.2 ng/mL ( 50 ). At these low PSA levels, conventional imaging has poor sensitivity for detecting sites of recurrence.…”