NCCN – National Comprehensive Cancer Network – The NCCN – Prostate Cancer – Clinical Practice Guidelines in Oncology – V2.2009 – 46 pages

Authors Mohler J, Amling CL, Bahnson RR, et al. 

References The intention of these Guildeines is to provide a framework on which to base treatment decisions. 131 references provided. 

Grade Grades of recommendation are all category 2A (NCCN) unless otherwise specified.

Coverage A series of algorithms are used to provide guidelines for the initial treatment options available for localized, locally advanced, metastatic and disseminated disease.

• For non-metastatic disease, initial therapy options are governed by life expectancy and the risk of recurrence. Life expectancy can be estimated by using the Social Security Administration tables.
• A range of treatment options including active surveillance, radical prostatectomy, radiotherapy, hormonal therapy and chemotherapy are identified. 
• Neoadjuvant +/– adjuvant hormonal therapy is recommended with external beam radiotherapy for patients with intermediate (4–6 months) or high-risk (2–3 years) cancer. 
• For patients with metastatic disease, the treatment guidelines are less complex and primarily involve hormonal therapy. 
• LHRH agonists (medical castration) and orchidectomy (surgical castration) are recommended options and are identified as being equally effective. 
• Combined androgen blockade (CAB) is also identified, but provides no proven benefit over castration alone. 
• Anti-androgen monotherapy is identified as not being as effective as castration in metastatic disease.
• Doxetaxel-based regimes are now the standard of care for castration recurrent metastatic prostate cancer with weekly docetaxel and prednisone being the preferred first-line regime.
• Zolendronic acid every 3–4 weeks is recommended to prevent disease-related skeletal events in patients with castration recurrent metastatic disease.

Source

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