The American Urological Association (AUA), American Society for Radiation Oncology (ASTRO), and Society of Urologic Oncology (SUO) released a new clinical practice guideline for the diagnosis and treatment of advanced prostate cancer.
The guideline was developed by a panel of experts from these three groups as well as representation from the American Society of Clinical Oncology (ASCO) and a patient advocate. It was distributed to peer reviewers before final approval and publication on the AUA website (June 25, 2020).
“This guideline is comprised of clinical recommendations based on new evidence and aims to further support the medical community and patients as they navigate through the various stages of this disease,” stated William Lowrance, MD, MPH, chair of the guideline panel, in a press release (June 25, 2020).
A total of 38 recommendations are listed across the care continuum of advanced disease, including early evaluation and counseling, biochemical recurrence without metastatic disease after exhaustion of local treatment options, metastatic hormone-sensitive disease, non-metastatic castration-resistant disease, metastatic castration-resistant disease, and bone health.
A notable recommendation in that guideline is that, “Clinicians should offer a PARP inhibitor to patients with deleterious or suspected deleterious germline or somatic homologous recombination repair gene-mutated metastatic castration-resistant prostate cancer following prior treatment with enzalutamide or abiraterone acetate, and/or a taxane-based chemotherapy. Platinum-based chemotherapy may be offered as an alternative for patients who cannot use or obtain a PARP inhibitor.”
Additionally, the panel acknowledged that treatment should be managed with a multidisciplinary approach as the therapeutic, imaging, and genetic landscape continues to evolve. Team members should include urologists, medical oncologists, and radiation oncologists at a minimum, and considerations for genitourinary pathologists, genetic counselors, and palliative care and holistic specialists should be given.—Zachary Bessette