AUA releases guideline on salvage therapy in prostate cancer

The American Urological Association (AUA), in collaboration with American Society for Radiation Oncology (ASTRO) and the Society of Urologic Oncology (SUO), has released the 2024 clinical practice guideline on salvage therapy in prostate cancer, the AUA announced in a news release.¹

“The considerations surrounding salvage therapy in prostate cancer have significantly evolved with the emergence of improved imaging and therapeutics," says Dan Lin, MD.

“With a focus on evidence-based approaches and a commitment to patient-centered care, this guideline will make a real difference for patients dealing with recurrence of their prostate cancer following initial treatment,” said Todd Morgan, MD, chair of the guideline panel, in the news release.¹ “Thanks to the incredible expertise of the entire panel, this guideline helps provide a roadmap that combines the latest advancements with thoughtful recommendations, empowering patients and clinicians alike.”

Overall, the guideline includes 30 recommendations related to salvage therapy for patients with biochemical recurrence following primary curative treatment for prostate cancer. According to the AUA, the guideline has a focus on the following topics.

• treatment decision-making at the time of suspected biochemical recurrence after primary radical prostatectomy
• treatment delivery for non-metastatic biochemical recurrence after primary radical prostatectomy
• evaluation and management of suspected non-metastatic recurrence after radiation therapy
• evaluation and management of suspected non-metastatic recurrence after focal therapy
• evaluation and management of regional recurrence
• management for molecular imaging metastatic recurrence

“Clinical trials involving large numbers of men show that radiation as a salvage therapy after radical prostatectomy can improve survival outcomes, delay cancer progression, and potentially offer a second chance at cure for many patients. This guideline provides a framework for multidisciplinary teams to personalize treatments based on best practices developed through decades of research,” said Ronald C. Chen, MD, MPH, FASTRO, in the news release.¹ Chen is the vice chair of the guideline panel and a professor and chair of radiation oncology at the University of Kansas Medical Center in Kansas City.

Summaries of the guideline statements have been broken up into 3 parts. Part 1 focuses on treatment decision-making at the time of suspected biochemical recurrence after radical prostatectomy.² Part 2 of the series includes a discussion on treatment delivery for non-metastatic biochemical recurrence following radical prostatectomy.³ Part 3 includes a focus on the evaluation and management of recurrence following radiotherapy and focal therapy, regional recurrence, and oligometastasis.⁴

The guideline recommendations are supported by data obtained from Ovid MEDLINE (from 1946 to July 21, 2022), Cochrane Central Register of Controlled Trials (through August 2022), and Cochrane Database of Systematic Reviews (through August 2022).

Panel members involved in the guideline’s creation include representation from urology/urologic oncology, radiation oncology, nuclear medicine, and medical oncology, in addition to patient representation. The panel members note that future improvements in outcomes with salvage therapies requires continuous and deliberate efforts for multidisciplinary care in prostate cancer.

SUO president Dan Lin, MD, concluded in the news release, “The considerations surrounding salvage therapy in prostate cancer have significantly evolved with the emergence of improved imaging and therapeutics. The new salvage therapy guideline provides practical, clear, and evidence-based recommendations for recurrence after surgery, radiation, and focal therapy, offering a multidisciplinary approach to the management of this clinical scenario.”¹

References

1. American Urological Association releases Salvage Therapy for Prostate Cancer Guideline. News release. American Urological Association. February 29, 2024. Accessed March 1, 2024. https://www.auanet.org/about-us/media-center/press-center/american-urological-association-releases-salvage-therapy-for-prostate-cancer-guideline

2. Morgan TM, Boorjian SA, Buyyounouski MK, et al. Salvage therapy for prostate cancer: AUA/ASTRO/SUO guideline part I: introduction and treatment decision-making at the time of suspected biochemical recurrence after radical prostatectomy. J Urol. 2024;211(4):509-517. https://www.auajournals.org/doi/10.1097/JU.0000000000003892

3. Morgan TM, Boorjian SA, Buyyounouski MK, et al. Salvage therapy for prostate cancer: AUA/ASTRO/SUO guideline part II: treatment delivery for non-metastatic biochemical recurrence after primary radical prostatectomy. J Urol. 2024;211(4):518-525. https://www.auajournals.org/doi/10.1097/JU.0000000000003891

4. Morgan TM, Boorjian SA, Buyyounouski MK, et al. Salvage therapy for prostate cancer: AUA/ASTRO/SUO guideline part III: salvage therapy after radiotherapy or focal therapy, pelvic nodal recurrence and oligometastasis, and future directions. J Urol. 2024;211(4):526-532. https://www.auajournals.org/doi/10.1097/JU.0000000000003890