AUA 2013: mCRPC guideline designed to assist in decision making

Following the rollout of several new treatments for metastatic, castration-resistant prostate cancer (mCRPC), a new AUA clinical guideline is aimed at assisting in clinical decision making.

Although mCRPC remains an incurable disease, new treatment-including immunotherapeutic, chemotherapeutic agents, anti-androgens, and androgen synthesis inhibitors-may improve outcomes in certain patients, according to the guideline. However, clinical decision making for patients with mCRPC is complex, due to the multiple options available for treatment and proper sequencing of these medications in patients, the AUA said in a statement.

The guideline provides an evidence-based rationale for the treatment of CRPC, but urges practitioners to use the guidance in conjunction with current literature and the individual patient’s treatment goals.

The guideline’s statements are specific to six different index patients, identified based on symptoms, performance status, the presence or absence of metastases, and whether or not docetaxel (Taxotere) has been administered. The six index patients are characterized as follows, with the full guideline providing specific treatment statements for each:

• index patient 1: asymptomatic, non-metastatic CRPC

• index patient 2: asymptomatic or minimally symptomatic, mCRPC without prior docetaxel chemotherapy

• index patient 3: symptomatic, mCRPC with good performance status and no prior chemotherapy

• index patient 4: symptomatic, mCRPC with poor performance status and no prior docetaxel chemotherapy

• index patient 5: symptomatic, mCRPC with good performance status and prior doxetaxel chemotherapy

• index patient 6: symptomatic, mCRPC with poor performance status and prior docetaxel chemotherapy.

"Prostate cancer deaths are typically the result of mCRPC, a painful disease for which, until recently, the only treatments available were palliative," said Michael Cookson, MD, of Vanderbilt-Ingram Cancer Center, Nashville, TN, who chaired the panel that developed the guideline. "In recent years, a number of new treatments and therapeutic agents have entered the market that have been shown to minimize adverse effects and pain and prolong survival in some patients, but the fact remains that mCRPC is the terminal stage of prostate cancer.

"As research continues in this area, we are hopeful that new developments will lead us closer to preventing the development of mCRPC."