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AUA – Guideline for the Management of Clinically Localized Prostate Cancer: 2007 Update – 82 Pages
Authors : Middleton RG, Thompson IA, Austenfeld MS et al.
References This is a comprehensive survey, analysis and assessment of published data, up-to 2004. Of the 12,501 scientific publications identified only 165 met the exacting standards of the panel of experts.
Grade There are 3 grades of assessment based on the strength of evidence and the panels views of patients needs and preferences. These grades include Standard, Recommendation and Option.
Coverage The Panel noted that a lack of evidence precluded specific recommendations for optimal treatment of an individual patient, and that patient preferences should guide decision-making.
The need to assess the patient’s life expectancy, overall health status and tumour characteristics, before any treatment decisions are made is adopted as a standard.
The need to assess the patient’s perception and understanding of the disease and its treatment is also adopted as a standard.
Treatment options are based on the following risk strata:
Low risk patients - should be informed that for EBRT a higher dose of radiation may decrease the risk of PSA recurrence and that for RP there is a lower risk of cancer recurrence and improved survival compared to watchful waiting.
Intermediate risk patients - should be informed that for EBRT, the use of hormonal therapy combined with conventional-dose radiotherapy may prolong survival, that for RP there is a lower risk of cancer recurrence and improved survival compared to watchful waiting and that for EBRT used alone a higher dose of radiation may decrease the risk of PSA recurrence.
High risk patients - should be informed that the use of hormonal therapy combined with conventional-dose radiotherapy may prolong survival, that for RP there is a lower risk of cancer recurrence and improved survival compared to watchful waiting
It is recommended that patients should be offered the opportunity to enroll in available clinical trials examining new forms of therapy, including combination therapies, with the goal of improved outcomes.
It is also recommended that whilst first-line hormone therapy is seldom indicated, an exception may be for the palliation of symptomatic patients with more extensive or poorly differentiated tumors whose life expectancy is too short to benefit from treatment with curative intent.
Source www.auanet.org/guidelines/proscan07.cfm
References This is a comprehensive survey, analysis and assessment of published data, up-to 2004. Of the 12,501 scientific publications identified only 165 met the exacting standards of the panel of experts.
Grade There are 3 grades of assessment based on the strength of evidence and the panels views of patients needs and preferences. These grades include Standard, Recommendation and Option.
Coverage The Panel noted that a lack of evidence precluded specific recommendations for optimal treatment of an individual patient, and that patient preferences should guide decision-making.
The need to assess the patient’s life expectancy, overall health status and tumour characteristics, before any treatment decisions are made is adopted as a standard.
The need to assess the patient’s perception and understanding of the disease and its treatment is also adopted as a standard.
Treatment options are based on the following risk strata:
- Low risk: PSA =10 ng/ml and a Gleason score of 6 or less and
clinical stage T1c or T2a - Intermediate risk: PSA >10 to 20 ng/ml or a Gleason score of 7 or
clinical stage T2b but not qualifying for high risk - High risk: PSA >20 ng/ml or a Gleason score of 8 to 10 or clinical
stage T2c
Low risk patients - should be informed that for EBRT a higher dose of radiation may decrease the risk of PSA recurrence and that for RP there is a lower risk of cancer recurrence and improved survival compared to watchful waiting.
Intermediate risk patients - should be informed that for EBRT, the use of hormonal therapy combined with conventional-dose radiotherapy may prolong survival, that for RP there is a lower risk of cancer recurrence and improved survival compared to watchful waiting and that for EBRT used alone a higher dose of radiation may decrease the risk of PSA recurrence.
High risk patients - should be informed that the use of hormonal therapy combined with conventional-dose radiotherapy may prolong survival, that for RP there is a lower risk of cancer recurrence and improved survival compared to watchful waiting
It is recommended that patients should be offered the opportunity to enroll in available clinical trials examining new forms of therapy, including combination therapies, with the goal of improved outcomes.
It is also recommended that whilst first-line hormone therapy is seldom indicated, an exception may be for the palliation of symptomatic patients with more extensive or poorly differentiated tumors whose life expectancy is too short to benefit from treatment with curative intent.
Source www.auanet.org/guidelines/proscan07.cfm
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