The American Urological Association (AUA), American Society for Radiation Oncology (ASTRO), and Society of Urologic Oncology (SUO) recently announced a new clinical practice guideline for the diagnosis and treatment of advanced prostate cancer.
Prostate cancer is one of the most commonly diagnosed cancers for U.S. men and remains the second leading cause of cancer death for this population. In 2020, approximately 192,000 men will be told they have prostate cancer and more than 33,000 U.S. deaths are estimated. Although cases of early-stage prostate cancer are declining, research suggests the incidence of advanced prostate cancer is on the rise.
William Lowrance, MD, MPH
“For the past several years, the prostate cancer landscape has been rapidly evolving due to changes in PSA [prostate-specific antigen] screening standards, as well as the approval of new classes of treatment options for use in various prostate cancer disease states,” said William Lowrance, MD, MPH, Chair of the guideline panel. “This guideline comprises clinical recommendations based on this new evidence and aims to further support the medical community and patients as they navigate through the various stages of this disease.”
Guideline Specifics
The guideline includes stages of advanced prostate cancer ranging from PSA recurrence after exhaustion of local treatment options to widespread metastatic disease. A total of 38 clinical recommendations were made across the following continuum of advanced prostate cancer:
- early evaluation and counseling
- biochemical recurrence without metastatic disease after exhaustion of local treatment options
- metastatic hormone-sensitive prostate cancer
- nonmetastatic castration-resistant prostate cancer
- metastatic castration-resistant prostate cancer
- bone health.
The panel also acknowledged that treatment of advanced prostate cancer must involve a multidisciplinary management approach as the therapeutic landscape evolves, encompassing increasingly complex combinations of systemic therapies and advances in imaging as well as germline and somatic genetic testing. At a minimum, team members should include urologists, medical oncologists, and radiation oncologists when supporting treatment decisions for advanced disease. Other members may include genitourinary pathologists, genetic counselors, and palliative care and holistic specialists, as appropriate, along with primary care providers.
The guideline was developed by a panel of experts from the AUA, ASTRO, and SUO and included additional representation from ASCO as well as a patient advocate. Additionally, it was distributed to peer reviewers of varying backgrounds as part of the AUA’s extensive peer-review process before being finally approved by the AUA Board of Directors and the other organizations. This clinical guideline is available online at www.AUAnet.org/Guidelines.
