What are the EAU/ESTRO/SIOG treatment guidelines for metastatic castration-resistant prostate cancer (CRPC)?

Updated: Jul 31, 2017
  • Author: Bagi RP Jana, MD; more...
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Answer

Answer

EAU, ESTRO and SIOG released a joint clinical practice guideline for prostate cancer in 2016. The guideline recommendations for patients with mCRPC  include the following [5] :

  • Treat with life prolonging agents (alphabetical order: abiraterone, docetaxel, enzalutamide, radium-223, sipuleucel-T). Base the choice of first line treatment on the performance status, symptoms, comorbidities and extent of disease.

  • Candidates for cytotoxic therapy should be offered docetaxel with 75 mg/m2 every 3 weeks.

  • In patients with progression following docetaxel chemotherapy, offer further life-prolonging treatment options, which include cabazitaxel, abiraterone, enzalutamide and radium-223.

  • Offer bone protective agents to patients with skeletal metastases to prevent osseous complications. However, the benefits must be balanced against the toxicity of these agents, and jaw necrosis, in particular, must be avoided.

  • Offer calcium and vitamin D supplementation when prescribing either denosumab or bisphosphonates.

  • Treat painful bone metastases early on with palliative measures such as EBRT, radionuclides, and adequate use of analgesics.

  • In patients with spinal cord compression, start immediate high-dose corticosteroids and assess for spinal surgery followed by irradiation. Offer radiation therapy alone if surgery is not appropriate.


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