Initial hormonal management of Androgen-sensitive metastatic, recurrent, or progressive prostate cancer: 2006 Update of an American society of clinical oncology practice guideline Review uri icon

Overview

MeSH Major

  • Androgen Antagonists
  • Antineoplastic Agents, Hormonal
  • Neoplasm Recurrence, Local
  • Prostate-Specific Antigen
  • Prostatic Neoplasms

abstract

  • Bilateral orchiectomy or luteinizing hormone-releasing hormone agonists are recommended initial androgen-deprivation treatments (ADTs). Nonsteroidal antiandrogen monotherapy merits discussion as an alternative; steroidal antiandrogen monotherapy should not be offered. Combined androgen blockade should be considered. In metastatic or progressive PCa, immediate versus symptom-onset institution of ADT results in a moderate decrease (17%) in relative risk (RR) for PCa-specific mortality, a moderate increase (15%) in RR for non-PCa-specific mortality, and no overall survival advantage. Therefore, the Panel cannot make a strong recommendation for early ADT initiation. Prostate-specific antigen (PSA) kinetics and other metrics allow identification of populations at high risk for PCa-specific and overall mortality. Further studies must be completed to assess whether patients with adverse prognostic factors gain a survival advantage from immediate ADT. For patients electing to wait until symptoms for ADT, regular monitoring visits are indicated. For patients with recurrence, clinical trials should be considered if available. Currently, data are insufficient to support use of intermittent androgen blockade outside clinical trials

publication date

  • April 20, 2007

Research

keywords

  • Review

Identity

Language

  • eng

Digital Object Identifier (DOI)

  • 10.1200/JCO.2006.10.1949

PubMed ID

  • 17404365

Additional Document Info

start page

  • 1596

end page

  • 605

volume

  • 25

number

  • 12