The American Urological Association (AUA), in partnership with the American Society for Radiation Oncology (ASTRO) and the Society of Urologic Oncology (SUO), released new clinical practice guidelines on salvage therapy for patients with prostate cancer. These guidelines were reported on by Morgan et al in The Journal of Urology.
Background
Although the definitive standard-of-care therapies can cure most patients with clinically localized prostate cancer, the risk of recurrence and subsequent metastasis is more than 50% in patients with the highest disease risk factors.
A significant area of prostate cancer care involves understanding the evaluation and appropriate use of salvage therapies for patients with biochemical recurrence. Balancing undertreatment with overtreatment, using novel therapeutic agents and imaging modalities, and optimizing patient selection with evidence-driven prognostic markers may all be critical to improving oncologic outcomes and maintaining the quality of life among these patients.
“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,” explained senior study author Ronald C. Chen, MD, MPH, FASTRO, Professor and Chair of Radiation Oncology at the University of Kansas Medical Center and Vice Chair of the Guideline Panel. “This guideline provides a framework for multidisciplinary teams to personalize treatments based on best practices developed through decades of research,” he added.
Guidelines Recommendations
The new clinical practice guidelines included 30 recommendations and may act as a valuable reference for effective evidence-based care related to salvage therapy for patients with prostate cancer.
The new guidelines offered recommendations regarding the following:
- Treatment decision-making at the time of suspected biochemical recurrence after primary radical prostatectomy
- Treatment delivery for nonmetastatic biochemical recurrence after primary radical prostatectomy
- Evaluation and management of suspected nonmetastatic recurrence after radiation therapy
- Evaluation and management of suspected nonmetastatic recurrence after focal therapy
- Evaluation and management of regional recurrence
- Management of metastatic recurrence with molecular imaging.
Conclusions
“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,” highlighted lead study author Todd Morgan, MD, Chair of the Guideline Panel. “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,” he emphasized.
“The considerations surrounding salvage therapy in prostate cancer have significantly evolved with the emergence of improved imaging and therapeutics,” underscored Dan Lin, MD, President of the SUO. “The new salvage therapy guidelines provide 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,” he concluded.
Disclosure: For full clinical practice guidelines, visit auajournals.org.
