Initial Management of Noncastrate Advanced, Recurrent, or Metastatic Prostate Cancer: ASCO Guideline Update.

Update all preceding ASCO guidelines on initial hormonal management of noncastrate advanced, recurrent, or metastatic prostate cancer.

The Expert Panel based recommendations on a systematic literature review. Recommendations were approved by the Expert Panel and the ASCO Clinical Practice Guidelines Committee.

Four clinical practice guidelines, one clinical practice guidelines endorsement, 19 systematic reviews with or without meta-analyses, 47 phase III randomized controlled trials, nine cohort studies, and two review papers informed the guideline update.

Docetaxel, abiraterone, enzalutamide, or apalutamide, each when administered with androgen deprivation therapy (ADT), represent four separate standards of care for noncastrate metastatic prostate cancer. Currently, the use of any of these agents in any particular combination or series cannot be recommended. ADT plus docetaxel, abiraterone, enzalutamide, or apalutamide should be offered to men with metastatic noncastrate prostate cancer, including those who received prior therapies, but have not yet progressed. The combination of ADT plus abiraterone and prednisolone should be considered for men with noncastrate locally advanced nonmetastatic prostate cancer who have undergone radiotherapy, rather than castration monotherapy. Immediate ADT may be offered to men who initially present with noncastrate locally advanced nonmetastatic disease who have not undergone previous local treatment and are unwilling or unable to undergo radiotherapy. Intermittent ADT may be offered to men with high-risk biochemically recurrent nonmetastatic prostate cancer. Active surveillance may be offered to men with low-risk biochemically recurrent nonmetastatic prostate cancer. The panel does not support use of either micronized abiraterone acetate or the 250 mg dose of abiraterone with a low-fat breakfast in the noncastrate setting at this time.Additional information is available at www.asco.org/genitourinary-cancer-guidelines.

Journal of clinical oncology : official journal of the American Society of Clinical Oncology. 2021 Jan 26 [Epub ahead of print]

Katherine S Virgo, R Bryan Rumble, Ronald de Wit, David S Mendelson, Thomas J Smith, Mary-Ellen Taplin, James L Wade, Charles L Bennett, Howard I Scher, Paul L Nguyen, Martin Gleave, Scott C Morgan, Andrew Loblaw, Sean Sachdev, David L Graham, Neha Vapiwala, Amy M Sion, Virgil H Simons, James Talcott

Emory University, Atlanta, GA., American Society of Clinical Oncology, Alexandria, VA., Erasmus MC, Rotterdam, NL., Virginia G Piper Cancer Network, Scottsdale, AZ., Johns Hopkins Medicine, Baltimore, MD., Dana-Farber Cancer Institute, Boston, MA., Cancer Care Specialists of Illinois, Decatur, IL., University of South Carolina College of Pharmacy, Columbia, SC., Memorial Sloan Kettering Cancer Center & Weill Cornell Medical College, New York, NY., University of British Columbia, Vancouver, BC, Canada., The Ottawa Hospital Cancer Centre, Ottawa, ON, Canada., Sunnybrook Health Sciences Centre, Toronto, ON, Canada., Northwestern University, Chicago, IL., Levine Cancer Institute, Charlotte, NC., University of Pennsylvania, Philadelphia, PA., Medical University of South Carolina, Charleston, SC., The Prostate Net, Sanford, NC., Nanhealth, Inc, Culver City, CA.