Originally published as JCO Early Release 10.1200/JCO.2006.10.1949 on April 2 2007

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Initial Hormonal Management of Androgen-Sensitive Metastatic, Recurrent, or Progressive Prostate Cancer: 2007 Update of an American Society of Clinical Oncology Practice Guideline

D. Andrew Loblaw, Katherine S. Virgo, Robert Nam, Mark R. Somerfield, Edgar Ben-Josef, David S. Mendelson, Richard Middleton, Stewart A. Sharp, Thomas J. Smith, James Talcott, Maryellen Taplin, Nicholas J. Vogelzang, James L. Wade, III, Charles L. Bennett, Howard I. Scher

From the American Society of Clinical Oncology, Alexandria, VA

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

Purpose To update the 2004 American Society of Clinical Oncology (ASCO) guideline on initial hormonal management of androgen-sensitive, metastatic, recurrent, or progressive prostate cancer (PCa).

Methods The writing committee based its recommendations on an updated systematic literature review. Recommendations were approved by the Expert Panel, the ASCO Health Services Committee, and the ASCO Board of Directors.

Results Seven randomized controlled trials (four new), one systematic review, one meta-analysis (new), one Markov model, and one delta-method 95% CI procedure for active controlled trials (new) informed the guideline update.

Recommendations 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.

published online ahead of print at www.jco.org on April 2, 2007.

Approved by the Board on November 2, 2006.

Authors’ disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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