NICE – National Institute for Health and Clinical Excellence – Prostate Cancer – Diagnosis and Treament – NICE Guideline 58 – February 2008 – 41 pages

Authors National Institute for Health and Clinical Excellence 

References This Guideline has been prepared using systematic reviews of the best available evidence and on the Guideline development group's opinion of what constitutes good practice. 

Grade This guidance represents the view of the Institute, which was arrived at after careful consideration of the evidence available. 

Coverage Recommendations include:

• Urological cancer multidisciplinary teams – should be available to advise, support and review the diagnosis, risk category and treatment options available to an individual patient.
• Low-risk localised disease – active surveillance followed by radical treatment (i.e. radical prostatectomy [RP] or radical radiotherapy [RT]). 
• High-risk localised disease – RP or RT alone. Adjuvant hormonal therapy for a minimum of 2 years should be used with RT in patients with a Gleason score of >8. 
• Locally advanced disease – Neoadjuvant and adjuvant LHRHa therapy is recommended for 3 to 6 months in men receiving radical radiotherapy for locally advanced prostate cancer. This should be extended to a minimum of 2 years in patients with a Gleason score of >8. 
• Metastatic disease – bilateral orchidectomy can be offered as an alternative to long-term LHRHa therapy. Combined androgen blockade (CAB) is not receommended as a first-line treatment. Bicalutamide (150 mg) can be offered to men who are hoping to maintain sexual function and who are willing to accept gynaecomastia and as adverse effect on survival. 
• Hormone refractory disease – docetaxel chemotherapy is recommended as a treatment option inmen with a Karnofsky PS score of 60%+. The use of bisphosphonates to prevent or reduce the complications of bone metastases is not recommended, but can be considered along with Stronium-89 for pain relief.  

Source

www.nice.org.uk