Originally published as JCO Early Release 10.1200/JCO.2004.04.579 on June 7 2004

This Article Full Text Full Text (PDF) Erratum (v22,p4435) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Save to my personal folders Download to citation manager Rights & Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Loblaw, D. A. Articles by Scher, H. I. Search for Related Content PubMed PubMed Citation Articles by Loblaw, D. A. Articles by Scher, H. I. Social Bookmarking                            What's this?

American Society of Clinical Oncology Recommendations for the Initial Hormonal Management of Androgen-Sensitive Metastatic, Recurrent, or Progressive Prostate Cancer

From the American Society of Clinical Oncology, Alexandria, VA

Address reprint requests to American Society of Clinical Oncology, Cancer Policy and Clinical Affairs, 1900 Duke St, Suite 200, Alexandria, VA 22314; e-mail: guidelines{at}asco.org

PURPOSE: To develop a clinical practice guideline for the management of men with metastatic, recurrent, or progressive carcinoma of the prostate. The focus of this document is on the use, combinations, and timing of various forms of androgen deprivation therapy (ADT) for the palliation of men with androgen-sensitive disease.

METHODS: An expert panel and writing committee were formed. The questions to be addressed by the guideline were determined, and a systematic review of the literature was performed, which included a search of online databases, bibliographic review, and consultation with content experts. A priori criteria were used to select studies for analysis and study authors were contacted when necessary.

RESULTS: There were 10 randomized controlled trials, six systematic reviews, and one Markov model available to inform the guidelines.

CONCLUSION: A full discussion between practitioner and patient should occur to determine which therapy is best for the patient. Bilateral orchiectomy or luteinizing hormone releasing hormone agonists are the recommended initial treatments. Nonsteroidal antiandrogen therapy may be discussed as an alternative, but steroidal antiandrogens should not be offered as monotherapy. Patients willing to accept the increased toxicity of combined androgen blockage for a small benefit in survival should be offered nonsteroidal antiandrogen in addition to castrate therapy. Until data from studies using modern medical diagnostic/biochemical tests and standardized follow-up schedules become available, no specific recommendations can be issued regarding the question of early versus deferred ADT. A discussion about the pros and cons of early versus deferred ADT should occur.

Authors' disclosures of potential conflicts of interest are found at the end of this article.

CiteULike    Complore    Connotea    Del.icio.us    Digg    Facebook    Reddit    Technorati    Twitter    What's this?

This article has been cited by other articles:

				K. E. Knudsen and H. I. Scher Starving the Addiction: New Opportunities for Durable Suppression of AR Signaling in Prostate Cancer Clin. Cancer Res., August 1, 2009; 15(15): 4792 - 4798. [Abstract] [Full Text] [PDF]

				W. Dale, J. Hemmerich, K. Bylow, S. Mohile, M. Mullaney, and W. M. Stadler Patient Anxiety About Prostate Cancer Independently Predicts Early Initiation of Androgen Deprivation Therapy for Biochemical Cancer Recurrence in Older Men: A Prospective Cohort Study J. Clin. Oncol., April 1, 2009; 27(10): 1557 - 1563. [Abstract] [Full Text] [PDF]

				M. R. Smith Rapid Testosterone Cycling and Chemotherapy for Prostate Cancer: A Way Forward or Return to the Past? J. Clin. Oncol., June 20, 2008; 26(18): 2932 - 2933. [Full Text] [PDF]

				2007 Update of ASCO Practice Guideline for the Initial Hormonal Management of Androgen-Sensitive Metastatic, Recurrent, or Progressive Prostate Cancer: Guideline Summary J. Oncol. Pract, May 1, 2007; 3(3): 175 - 177. [Full Text] [PDF]

				D. A. Loblaw, K. S. Virgo, R. Nam, M. R. Somerfield, E. Ben-Josef, D. S. Mendelson, R. Middleton, S. A. Sharp, T. J. Smith, J. Talcott, et al. Initial Hormonal Management of Androgen-Sensitive Metastatic, Recurrent, or Progressive Prostate Cancer: 2007 Update of an American Society of Clinical Oncology Practice Guideline J. Clin. Oncol., April 20, 2007; 25(12): 1596 - 1605. [Abstract] [Full Text] [PDF]

				M. R. Smith Obesity and Sex Steroids during Gonadotropin-Releasing Hormone Agonist Treatment for Prostate Cancer Clin. Cancer Res., January 1, 2007; 13(1): 241 - 245. [Abstract] [Full Text] [PDF]

				N. Sharifi, J. L. Gulley, and W. L. Dahut Androgen Deprivation Therapy for Prostate Cancer JAMA, July 13, 2005; 294(2): 238 - 244. [Abstract] [Full Text] [PDF]

				G S Harrison, M E Wierman, T M Nett, and L M Glode Gonadotropin-releasing hormone and its receptor in normal and malignant cells Endocr. Relat. Cancer, December 1, 2004; 11(4): 725 - 748. [Abstract] [Full Text] [PDF]