This is the current release of the guideline.

This guideline updates a previous version: Loblaw DA, Mendelson DS, Talcott JA, Virgo KS, Somerfield MR, Ben-Josef E, Middleton R, Porterfield H, Sharp SA, Smith TJ, Taplin ME, Vogelzang NJ, Wade JL Jr, Bennett CL, Scher HI. American Society of Clinical Oncology recommendations for the initial hormonal management of androgen-sensitive metastatic, recurrent, or progressive prostate cancer. J Clin Oncol 2004 Jul 15;22(14):2927-41.

1. What are the standard initial treatment options?

   2006 Recommendation: Bilateral orchiectomy or medical castration with luteinizing hormone-releasing hormone (LHRH) agonists are the recommended initial treatments for metastatic prostate cancer. A full discussion between practitioner and patient should occur to determine which is best for the patient. Diethylstilbestrol (DES) should not be considered as a standard first-line treatment option and is no longer commercially available in North America.

2. Are antiandrogens as effective as other castration therapies?

   2006 Recommendation: Nonsteroidal antiandrogen (NSAA) monotherapy may be discussed as an alternative, but steroidal antiandrogen (AA) monotherapy should not be offered.

3. Is combined androgen blockade better than castration alone?

   2006 Recommendation: Combined androgen blockade (CAB) should be considered.

4. Does early androgen-deprivation treatment (ADT) improve outcomes over deferred therapy?

   2006 Recommendation: For patients with metastatic or progressive prostate cancer, there is a moderate decrease (17%) in relative risk (RR) for prostate cancer–specific mortality, a moderate increase (15%) in RR for non–prostate cancer–specific mortality, and no overall survival advantage for immediate institution of androgen-deprivation treatment (ADT) versus waiting until symptom onset for patients. Therefore, the Panel cannot make a strong recommendation for the early use of ADT. Prostate-specific antigen (PSA) kinetics and other metrics allow the identification of populations at high risk for prostate cancer–specific and overall mortality. Further studies must be completed to assess whether patients with adverse prognostic factors gain a survival advantage from immediate ADT. If a patient decides to wait until symptoms for ADT, he should have regular visits for monitoring. For patients with recurrent disease, clinical trials should be considered if available.

5. What is the role of intermittent androgen blockade?

   2006 Recommendation: Currently, data are insufficient to support the use of intermittent androgen blockade outside of clinical trials.

A clinical algorithm is provided for the initial hormonal management of androgen-sensitive advanced cancer (see "Availability of Companion Documents" field in this summary).

The recommendations are supported by randomized controlled trials, a systematic review, a meta-analysis, one Markov model, and one delta-method 95% confidence interval (CI) procedure for active controlled trials.

Not applicable: The guideline was not adapted from another source.

2004 Jun 7 (revised 2007 Apr)

American Society of Clinical Oncology - Medical Specialty Society

American Society of Clinical Oncology (ASCO)

American Society of Clinical Oncology (ASCO) Metastatic Prostate Cancer Expert Panel

Primary Authors: 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

ASCO Metastatic Prostrate Cancer Expert Panel: Howard I. Scher, MD, Cochair Memorial Sloan-Kettering Cancer Center; Charles L. Bennett, MD, PhD, Cochair VA Chicago Health Care System-Lakeside and the Robert H. Lurie Comprehensive Cancer Center of Northwestern University; Edgar Ben-Josef, MD, Wayne State University; D. Andrew Loblaw, MD, MSc, Sunnybrook Health Sciences Centre; David S. Mendelson, MD, Premiere Oncology of Arizona; Richard Middleton, MD, University of Utah Medical School; Robert Nam, MD, MSc, Sunnybrook Health Sciences Centre; Thomas J. Smith, MD, Massey Cancer Center, Medical College of Virginia; Stewart A. Sharp, MD, Danville Hematology & Oncology, Inc; James Talcott, MD,MPH, Massachusetts General Hospital; Maryellen Taplin, MD, Dana-Farber Cancer Institute; Katherine S. Virgo, PhD, Saint Louis University & Department of Veterans' Affairs Medical Center; Nicholas J. Vogelzang, MD, University of Chicago Cancer Research Center; James L. Wade III, MD, Cancer Care Specialists of Central Illinois

Although all authors completed the disclosure declaration, the following authors or their immediate family members indicated a financial interest.

No conflict exists for drugs or devices used in a study if they are not being evaluated as part of the investigation. For a detailed description of the disclosure categories, or for more information about ASCO's conflict of interest policy, please refer to the Author Disclosure Declaration and the Disclosures of Potential Conflicts of Interest section in Information for Contributors.

Employment: N/A Leadership: N/A Consultant: D. Andrew Loblaw, Astra Zeneca; Nicholas J. Vogelzang, Sanofi Aventis; Charles L. Bennett, Sanofi, Millenium Stock: N/A Honoraria: D. Andrew Loblaw, Astra Zeneca; James Talcott, Dendreon; Maryellen Taplin, Astra Zeneca; Nicholas J. Vogelzang, Astra Zeneca Research Funds: D. Andrew Loblaw, Astra Zeneca; Nicholas J. Vogelzang, Astra Zeneca; Charles L. Bennett, Amgen, Sanofi Testimony: N/A Other: D. Andrew Loblaw, Astra Zeneca, Sanofi-Aventis

This is the current release of the guideline.

This guideline updates a previous version: Loblaw DA, Mendelson DS, Talcott JA, Virgo KS, Somerfield MR, Ben-Josef E, Middleton R, Porterfield H, Sharp SA, Smith TJ, Taplin ME, Vogelzang NJ, Wade JL Jr, Bennett CL, Scher HI. American Society of Clinical Oncology recommendations for the initial hormonal management of androgen-sensitive metastatic, recurrent, or progressive prostate cancer. J Clin Oncol 2004 Jul 15;22(14):2927-41.

This NGC summary was completed by ECRI on August 11, 2004. The information was verified by the guideline developer on August 13, 2004. This NGC summary was updated by ECRI Institute on June 26, 2007. The updated information was verified by the guideline developer on July 16, 2007.

This summary is based on the original guideline, which is subject to the American Society of Clinical Oncology's copyright restrictions.