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MONDAY, Sept. 8, 2014 (HealthDay News) -- Men newly diagnosed with prostate cancer often turn first to testosterone-depleting therapies, since male hormones help prostate tumors grow.
But, those therapies almost always fail over time as the tumor develops resistance, according to oncologists.
Now, experts are issuing updated guidelines to help patients in this situation decide what to do next.
The guidelines, issued jointly by the American Society of Clinical Oncology (ASCO) and Cancer Care Ontario (CCO) in Canada, highlight recent advances in treating this more advanced form of prostate cancer.
"We have seen unprecedented progress against advanced prostate cancer recently, with six new treatments approved in the last couple of years," Dr. Ethan Basch, co-chair of the ASCO/CCO panel of experts that developed the guidelines, said in a news release from the two groups.
"There are a lot of nuances about treatment selection in terms of disease stage and what prior therapies the patient received," he said. "We hope this guideline will help doctors and patients make informed treatment decisions."
After a prostate tumor becomes resistant to hormonal treatment, other therapies may come into use. But the ASCO/CCO team said they took men's quality of life into consideration as well when they drew up their guidelines.
"Including quality of life data in the guideline helps people understand how the different treatments will make them feel," Dr. Andrew Loblaw, co-chair of the ASCO/CCO expert panel, said in the news release. "We also have to be conscious of cost, because it can affect access to treatment and quality of life."
The new guidelines for hormone therapy-resistant tumors that have spread (metastasized) include the following recommendations:
- Continue hormone-deprivation therapy indefinitely, either in drug or surgical form;
- Offer patients one of three treatment options -- abiraterone/prednisone, enzalutamide, or radium-223 (if cancer has spread to the bones) -- in addition to hormone deprivation, "as all three treatments are associated with improved survival, quality of life, and favorable balance of benefits and harms";
- When considering chemotherapy, docetaxel/prednisone should be an option but side effects must be discussed;
- Offer cabazitaxel to men whose disease worsens even if docetaxel has been tried, but again, discuss side effects;
- Offer sipuleucel-T to men with no symptoms or minimal symptoms of cancer;
- Offer mitoxantrone, but include a discussion of the drug's "limited clinical benefit and side effect risk";
- Offer ketoconazole or the anti-androgen therapies bicalutamide, flutamide or nilutamide but discuss the limited clinical benefit for these three medications;
- Do not offer the drugs bevacizumab (Avastin), estramustine, or sunitinib;
- Begin discussion of palliative care early on while discussing treatment options.
The experts on the panel said the optimum sequence in which various treatment should be given remains unclear, but "ongoing clinical trials are exploring this question, as well as potential benefits of combining various treatments."
The new guidelines are based on a review of 56 randomized clinical trials published since 1979, the panel experts said.
According to the American Cancer Society, prostate cancer remains the leading cancer type for men, other than skin cancer. More than 233,000 new cases of prostate cancer are diagnosed in the United States each year, and almost 30,000 men die from the illness annually. But most men diagnosed with prostate cancer don't die from it. More than 2.5 million American men diagnosed with the disease are still alive.
-- E.J. Mundell
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