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EAU – Guidelines on Prostate Cancer – 2007 – 114 pages
Authors Heidenreich A, Aus G, Abbou CC, Bolla M et al + EAU Working Group on Oncological Urology
References Level of evidence (1a – 4) as used by US Department of Health and Human Services, Public Health Service, Agency for Health Care Policy and Research,
Grade Grade of recommendations (A – C) as used by US Department of Health and Human Services, Public Health Service, Agency for Health Care Policy and
Research,
Coverage Sections on classification, risk factors, screening, diagnosis and staging together with various treatment types i.e. deferred treatment, radical prostatectomy, radiotherapy, local treatment (e.g. cryosurgery and HIFU) and hormonal therapy are included. The key conclusions with respect to hormonal therapy include:
In addition there are summary tables of Guidelines on Primary Treatment for each Tumour Stage i.e. from T1a to M+. For example with respect to T3 – T4
References Level of evidence (1a – 4) as used by US Department of Health and Human Services, Public Health Service, Agency for Health Care Policy and Research,
Grade Grade of recommendations (A – C) as used by US Department of Health and Human Services, Public Health Service, Agency for Health Care Policy and
Research,
Coverage Sections on classification, risk factors, screening, diagnosis and staging together with various treatment types i.e. deferred treatment, radical prostatectomy, radiotherapy, local treatment (e.g. cryosurgery and HIFU) and hormonal therapy are included. The key conclusions with respect to hormonal therapy include:
- In advanced disease, androgen deprivation therapy (ADT) delays progression, prevents potentially catastrophic complications and effectively palliates symptoms, but does not prolong survival
- In advanced disease, all forms of castration as monotherapy (orchiectomy, LHRH and DES) have equivalent therapeutic efficacy
- Non-steroidal anti-androgen monotherapy (e.g. bicalutamide) is an effective alternative to castration in patients with locally advanced disease.
- In advanced disease the addition of a non-steroidal anti-androgen to castration (CAB) results in a small advantage in overall survival over castration alone. However it is associated with increased incidence of adverse events, reduced QoL and high costs.
- Intermittent and ‘minimal’ ADT should still be regarded as experimental.
- In advanced disease, immediate (given at diagnosis) ADT significantly reduces disease progression and complication rate due to progression itself compared to deferred (delivered at symptomatic progression) ADT.
- Bilateral orchiectomy may be the most cost-effective form of ADT, especially if initiated after occurrence of symptoms from metastatic disease.
In addition there are summary tables of Guidelines on Primary Treatment for each Tumour Stage i.e. from T1a to M+. For example with respect to T3 – T4
- Watchful Waiting is an option in asymptomatic patients with well-differentiated and moderately differentiated T3 tumours and with a life expectancy < 10 years
- Radical Prostatectomy is optional for selected patients with T3a and a life expectancy > 10 years
- Radiotherapy is indicated for T3 with > 5-10 years of life expectancy. Dose escalation > 70 Gy seems to be of benefit. If this is not available, a combination with hormonal therapy could be recommended (see below)
- Hormonal Therapy is indicated for symptomatic patients, extensive T3-T4, high PSA level (> 25 ng/mL), unfit patients. Better than watchful waiting.
- Combination Therapy - radiotherapy + hormonal therapy seems better than radiotherapy alone. NHT + radical prostatectomy: no proven benefit
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