Initial hormonal management of Androgen-sensitive metastatic, recurrent, or progressive prostate cancer

2006 Update of an American society of clinical oncology practice guideline

D. Andrew Loblaw, Katherine S. Virgo, Robert Nam, Mark R. Somerfield, Edgar Ben-Josef, David S. Mendelson, Richard Middleton, Stewart A. Sharp, Thomas J Smith, James Talcott, Maryellen Taplin, Nicholas J. Vogelzang, James L. Wade, Charles L. Bennett, Howard I. Scher

Research output: Contribution to journalArticle

Abstract

Purpose: To update the 2004 American Society of Clinical Oncology (ASCO) guideline on initial hormonal management of androgen-sensitive, metastatic, recurrent, or progressive prostate cancer (PCa). Methods: The writing committee based its recommendations on an updated systematic literature review. Recommendations were approved by the Expert Panel, the ASCO Health Services Committee, and the ASCO Board of Directors. Results: Seven randomized controlled trials (four new), one systematic review, one meta-analysis (new), one Markov model, and one delta-method 95% CI procedure for active controlled trials (new) informed the guideline update. Recommendations: Bilateral orchiectomy or luteinizing hormone-releasing hormone agonists are recommended initial androgen-deprivation treatments (ADTs). Nonsteroidal antiandrogen monotherapy merits discussion as an alternative; steroidal antiandrogen monotherapy should not be offered. Combined androgen blockade should be considered. In metastatic or progressive PCa, immediate versus symptom-onset institution of ADT results in a moderate decrease (17%) in relative risk (RR) for PCa-specific mortality, a moderate increase (15%) in RR for non-PCa-specific mortality, and no overall survival advantage. Therefore, the Panel cannot make a strong recommendation for early ADT initiation. Prostate-specific antigen (PSA) kinetics and other metrics allow identification of populations at high risk for PCa-specific and overall mortality. Further studies must be completed to assess whether patients with adverse prognostic factors gain a survival advantage from immediate ADT. For patients electing to wait until symptoms for ADT, regular monitoring visits are indicated. For patients with recurrence, clinical trials should be considered if available. Currently, data are insufficient to support use of intermittent androgen blockade outside clinical trials.

Original languageEnglish (US)
Pages (from-to)1596-1605
Number of pages10
JournalJournal of Clinical Oncology
Volume25
Issue number12
DOIs
StatePublished - Apr 20 2007
Externally publishedYes

Fingerprint

Medical Oncology
Practice Guidelines
Androgens
Prostatic Neoplasms
Mortality
Nonsteroidal Anti-Androgens
Clinical Trials
Guidelines
Therapeutics
Androgen Antagonists
Survival
Orchiectomy
Prostate-Specific Antigen
Gonadotropin-Releasing Hormone
Health Services
Meta-Analysis
Randomized Controlled Trials
Recurrence

ASJC Scopus subject areas

  • Cancer Research
  • Oncology
  • Medicine(all)

Cite this

Initial hormonal management of Androgen-sensitive metastatic, recurrent, or progressive prostate cancer : 2006 Update of an American society of clinical oncology practice guideline. / Loblaw, D. Andrew; Virgo, Katherine S.; Nam, Robert; Somerfield, Mark R.; Ben-Josef, Edgar; Mendelson, David S.; Middleton, Richard; Sharp, Stewart A.; Smith, Thomas J; Talcott, James; Taplin, Maryellen; Vogelzang, Nicholas J.; Wade, James L.; Bennett, Charles L.; Scher, Howard I.

In: Journal of Clinical Oncology, Vol. 25, No. 12, 20.04.2007, p. 1596-1605.

Research output: Contribution to journalArticle

Loblaw, DA, Virgo, KS, Nam, R, Somerfield, MR, Ben-Josef, E, Mendelson, DS, Middleton, R, Sharp, SA, Smith, TJ, Talcott, J, Taplin, M, Vogelzang, NJ, Wade, JL, Bennett, CL & Scher, HI 2007, 'Initial hormonal management of Androgen-sensitive metastatic, recurrent, or progressive prostate cancer: 2006 Update of an American society of clinical oncology practice guideline', Journal of Clinical Oncology, vol. 25, no. 12, pp. 1596-1605. https://doi.org/10.1200/JCO.2006.10.1949
Loblaw, D. Andrew ; Virgo, Katherine S. ; Nam, Robert ; Somerfield, Mark R. ; Ben-Josef, Edgar ; Mendelson, David S. ; Middleton, Richard ; Sharp, Stewart A. ; Smith, Thomas J ; Talcott, James ; Taplin, Maryellen ; Vogelzang, Nicholas J. ; Wade, James L. ; Bennett, Charles L. ; Scher, Howard I. / Initial hormonal management of Androgen-sensitive metastatic, recurrent, or progressive prostate cancer : 2006 Update of an American society of clinical oncology practice guideline. In: Journal of Clinical Oncology. 2007 ; Vol. 25, No. 12. pp. 1596-1605.
@article{f624a57fe2714ef0914e39be67ab6b05,
title = "Initial hormonal management of Androgen-sensitive metastatic, recurrent, or progressive prostate cancer: 2006 Update of an American society of clinical oncology practice guideline",
abstract = "Purpose: To update the 2004 American Society of Clinical Oncology (ASCO) guideline on initial hormonal management of androgen-sensitive, metastatic, recurrent, or progressive prostate cancer (PCa). Methods: The writing committee based its recommendations on an updated systematic literature review. Recommendations were approved by the Expert Panel, the ASCO Health Services Committee, and the ASCO Board of Directors. Results: Seven randomized controlled trials (four new), one systematic review, one meta-analysis (new), one Markov model, and one delta-method 95{\%} CI procedure for active controlled trials (new) informed the guideline update. Recommendations: Bilateral orchiectomy or luteinizing hormone-releasing hormone agonists are recommended initial androgen-deprivation treatments (ADTs). Nonsteroidal antiandrogen monotherapy merits discussion as an alternative; steroidal antiandrogen monotherapy should not be offered. Combined androgen blockade should be considered. In metastatic or progressive PCa, immediate versus symptom-onset institution of ADT results in a moderate decrease (17{\%}) in relative risk (RR) for PCa-specific mortality, a moderate increase (15{\%}) in RR for non-PCa-specific mortality, and no overall survival advantage. Therefore, the Panel cannot make a strong recommendation for early ADT initiation. Prostate-specific antigen (PSA) kinetics and other metrics allow identification of populations at high risk for PCa-specific and overall mortality. Further studies must be completed to assess whether patients with adverse prognostic factors gain a survival advantage from immediate ADT. For patients electing to wait until symptoms for ADT, regular monitoring visits are indicated. For patients with recurrence, clinical trials should be considered if available. Currently, data are insufficient to support use of intermittent androgen blockade outside clinical trials.",
author = "Loblaw, {D. Andrew} and Virgo, {Katherine S.} and Robert Nam and Somerfield, {Mark R.} and Edgar Ben-Josef and Mendelson, {David S.} and Richard Middleton and Sharp, {Stewart A.} and Smith, {Thomas J} and James Talcott and Maryellen Taplin and Vogelzang, {Nicholas J.} and Wade, {James L.} and Bennett, {Charles L.} and Scher, {Howard I.}",
year = "2007",
month = "4",
day = "20",
doi = "10.1200/JCO.2006.10.1949",
language = "English (US)",
volume = "25",
pages = "1596--1605",
journal = "Journal of Clinical Oncology",
issn = "0732-183X",
publisher = "American Society of Clinical Oncology",
number = "12",

}

TY - JOUR

T1 - Initial hormonal management of Androgen-sensitive metastatic, recurrent, or progressive prostate cancer

T2 - 2006 Update of an American society of clinical oncology practice guideline

AU - Loblaw, D. Andrew

AU - Virgo, Katherine S.

AU - Nam, Robert

AU - Somerfield, Mark R.

AU - Ben-Josef, Edgar

AU - Mendelson, David S.

AU - Middleton, Richard

AU - Sharp, Stewart A.

AU - Smith, Thomas J

AU - Talcott, James

AU - Taplin, Maryellen

AU - Vogelzang, Nicholas J.

AU - Wade, James L.

AU - Bennett, Charles L.

AU - Scher, Howard I.

PY - 2007/4/20

Y1 - 2007/4/20

N2 - Purpose: To update the 2004 American Society of Clinical Oncology (ASCO) guideline on initial hormonal management of androgen-sensitive, metastatic, recurrent, or progressive prostate cancer (PCa). Methods: The writing committee based its recommendations on an updated systematic literature review. Recommendations were approved by the Expert Panel, the ASCO Health Services Committee, and the ASCO Board of Directors. Results: Seven randomized controlled trials (four new), one systematic review, one meta-analysis (new), one Markov model, and one delta-method 95% CI procedure for active controlled trials (new) informed the guideline update. Recommendations: Bilateral orchiectomy or luteinizing hormone-releasing hormone agonists are recommended initial androgen-deprivation treatments (ADTs). Nonsteroidal antiandrogen monotherapy merits discussion as an alternative; steroidal antiandrogen monotherapy should not be offered. Combined androgen blockade should be considered. In metastatic or progressive PCa, immediate versus symptom-onset institution of ADT results in a moderate decrease (17%) in relative risk (RR) for PCa-specific mortality, a moderate increase (15%) in RR for non-PCa-specific mortality, and no overall survival advantage. Therefore, the Panel cannot make a strong recommendation for early ADT initiation. Prostate-specific antigen (PSA) kinetics and other metrics allow identification of populations at high risk for PCa-specific and overall mortality. Further studies must be completed to assess whether patients with adverse prognostic factors gain a survival advantage from immediate ADT. For patients electing to wait until symptoms for ADT, regular monitoring visits are indicated. For patients with recurrence, clinical trials should be considered if available. Currently, data are insufficient to support use of intermittent androgen blockade outside clinical trials.

AB - Purpose: To update the 2004 American Society of Clinical Oncology (ASCO) guideline on initial hormonal management of androgen-sensitive, metastatic, recurrent, or progressive prostate cancer (PCa). Methods: The writing committee based its recommendations on an updated systematic literature review. Recommendations were approved by the Expert Panel, the ASCO Health Services Committee, and the ASCO Board of Directors. Results: Seven randomized controlled trials (four new), one systematic review, one meta-analysis (new), one Markov model, and one delta-method 95% CI procedure for active controlled trials (new) informed the guideline update. Recommendations: Bilateral orchiectomy or luteinizing hormone-releasing hormone agonists are recommended initial androgen-deprivation treatments (ADTs). Nonsteroidal antiandrogen monotherapy merits discussion as an alternative; steroidal antiandrogen monotherapy should not be offered. Combined androgen blockade should be considered. In metastatic or progressive PCa, immediate versus symptom-onset institution of ADT results in a moderate decrease (17%) in relative risk (RR) for PCa-specific mortality, a moderate increase (15%) in RR for non-PCa-specific mortality, and no overall survival advantage. Therefore, the Panel cannot make a strong recommendation for early ADT initiation. Prostate-specific antigen (PSA) kinetics and other metrics allow identification of populations at high risk for PCa-specific and overall mortality. Further studies must be completed to assess whether patients with adverse prognostic factors gain a survival advantage from immediate ADT. For patients electing to wait until symptoms for ADT, regular monitoring visits are indicated. For patients with recurrence, clinical trials should be considered if available. Currently, data are insufficient to support use of intermittent androgen blockade outside clinical trials.

UR - http://www.scopus.com/inward/record.url?scp=34248169161&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=34248169161&partnerID=8YFLogxK

U2 - 10.1200/JCO.2006.10.1949

DO - 10.1200/JCO.2006.10.1949

M3 - Article

VL - 25

SP - 1596

EP - 1605

JO - Journal of Clinical Oncology

JF - Journal of Clinical Oncology

SN - 0732-183X

IS - 12

ER -