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ASCO Recommendations for Prostate Cancer

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The American Society of Clinical Oncology (ASCO) has recently developed evidence-based recommendations for the treatment of advanced prostate cancer that has stopped responding to surgical castration. These results were recently published in the Journal of Clinical Oncology.

Prostate cancer is one of the most common types of cancers among men in the United States. Since prostate cancer cells are stimulated to grow from exposure to the male hormone, testosterone, surgical castration to remove the main source of testosterone is an option.

Unfortunately, the cancer will sometimes grow back, despite surgical castration and is referred to as castration-resistant prostate cancer (CRPC).

ASCO and the Cancer Care Ontario recently “convened an expert panel to develop evidence-based recommendations informed by a systematic review of literature” for the treatment of CRPC that had spread to distant sites in the body.

The following is an overview of the new recommendations, which include therapies combined with androgen deprivation therapies indefinitely:

Improved survival, quality of life and a favorable benefit-harm balance was demonstrated by the following agents:
Abiraterone acetate/prednisone
Enzalutamide
Radium-223 (for patients whose cancer has spread predominantly to the bone).
Docetaxel/prednisone (moderate side effects which should be discussed prior to therapy).
For men with no, or minimal symptoms of cancer, improved survival with unclear quality of life impact was demonstrated by the following agents:
Sipuleucel-T (minimal side effects).
Cabazitaxel/prednisone (for men who received prior docetaxel; associated with modest to severe side effects which should be discussed prior to treatment).
Among patients whose cancer has progressed following docetaxel, patients may be offered the following:
Cabazitaxel, mitoxantrone, ketoconzaole or antiandrogens (e.g., bicalutamide, flutamide, milutamide) may be offered, all with discussion of side effects and clinical benefit.
Bevacizumab, estramustine and sunitinib should not be offered, as there is not enough evidence to determine optimal sequences or combinations.
Patients with advanced CRPC should speak with their physician regarding all of their options, including side effects and clinical benefit of each.

Reference: Basch E, Loblaw D, Oliver T, et al. Systemic therapy in men with metastatic castration-resistant prostate cancer: American Society of Clinical Oncology and Cancer Care Ontario Clinic Practice Guidelines. DOI: 10.1200/JCO.2013.54.8404. Available at: http://jco.ascopubs.org/content/early/2014/09/03/JCO.2013.54.8404