There was a lot of interesting and important presentations at the recent American Urological Association meeting, however the one item that will have the most impact on men with advanced prostate cancer is the new guidelines that were proposed for the treatment of men with castrate resistant prostate cancer.
The guidelines were organized by creating six different “indexes” which describe the disease state being treated. The indexes are:
1. Asymptomatic non-metastatic CRPC
2. Asymptomatic or minimally-symptomatic, mCRPC without prior docetaxel chemotherapy
3. Symptomatic, mCRPC with good performance status and no prior docetaxel chemotherapy
4. Symptomatic, mCRPC with poor performance status and no prior docetaxel chemotherapy
5. Symptomatic, mCRPC with good performance status and prior docetaxel chemotherapy
6. Symptomatic, mCRPC with poor performance status and prior docetaxel chemotherapy
In each index the committee designing the guidelines indicated what drugs would be appropriate for each disease index. In reviewing each index it is clear that the members followed the specific FDA prescribing label for each disease state, defined by the committee as being evidence based, thus not allowing any creative flexibility by a doctor. One can hope that oncologists and urologists treating men with advanced, metastatic prostate cancer will still feel empowered to diverge from the guidelines at the appropriate moments.
The full guidelines, along with the description of each index can be seen at the AUA website at: Guideline.
The AUA has also published a flow chart of this guideline which can be viewed at: Flow Chart
Joel T Nowak, M.A., M.S.W.