In recent years, new therapeutic options have brought improvements in the treatment of metastatic, castration-resistant prostate cancer. Targeted Hormone Therapy (THT) represents a novel therapeutic component for which recent studies have shown a maximum benefit in the time between failure of androgen deprivation therapy (patient is metastatic and still pain-free) and prior to chemotherapy.
Prostate cancer experts of the Austrian Society of Urology and Andrology (ÖGU), the Working Group for Urologic Oncology as part of the ÖGU, and the Professional Association of Austrian Urologists (BvU) have developed recommendations for the treatment of patients with asymptomatic or mildly symptomatic metastatic, castration-resistant prostate cancer. The definition of failure of classical hormonal therapy has been based on the guidelines of the German Society of Urology (Deutsche Gesellschaft für Urologie, DGU) and the European Association of Urology (EAU). Criteria for the initiation of treatment with hormonal or chemotherapy include: Castration resistance with increase of prostate-specific antigen (PSA) Evidence of metastases in imaging No or mild symptoms Quality of Life Index of the Eastern Cooperative Oncology Group (ECOG) 0-1 (ECOG 2 requires individualized decision) . Treatment should only be initiated when all of these four criteria are applicable, with the age of the patient being no exclusion criterion. First-line therapies for these patients include abiraterone, enzalutamide, and docetaxel as well as radium-223. The manuscript refers only to treatment regimens available in Austria. Selection of the initial treatment option-starting with THT or chemotherapy-should be determined based on the individual patient characteristics. When using abiraterone or enzalutamide, re-staging within 3-6 months is recommended.
Wiener klinische Wochenschrift. 2016 Feb 01 [Epub ahead of print]
Anton Ponholzer, Wolfgang Loidl, Jasmin Bektic, Karl Dorfinger, Stephan Hruby, Klaus Jeschke, Gero Kramer, Steffen Krause, Georg Ludvik, Mesut Remzi, Michael Roider, Franz Stoiber
Department of Urology and Andrology, Working Group Urologic Oncology (AUO), Hospital Barmherzige Brüder Vienna, Vienna, Austria. Department of Urology, Austrian Society of Urology and Andrology (ÖGU), Hospital Barmherzige Schwestern Linz, Linz, Austria. European Prostate Center, University Hospital of Urology, Innsbruck, Austria. Urology and Andrology in Vienna, Professional Association of Austrian Urologists (BvU), Vienna, Austria. Urology and Andrology, University Hospital, Salzburg, Austria. Department of Urology and Andrology, Clinic Center Klagenfurt am Wörthersee, Klagenfurt am Wörthersee, Austria. Urologic Outpatient Tumor Unit, University Hospital of Urology, Vienna, Austria. Department of Urology, General Hospital of the City of Linz, Linz, Austria. Urology & Andrology, Vienna, Austria. Department of Urology, Provincial Hospital Korneuburg, Korneuburg, Austria. KABEG, Clinic Center Klagenfurt am Wörthersee, Klagenfurt am Wörthersee, Austria. Department of Urology, Provincial Hospital Vöcklabruck, Vöcklabruck, Austria.