AUA, ASTRO, SUO release localized PCa guideline

June 5, 2017

Among the guideline’s recommendations is that active surveillance should serve as the preferred method of care for low-risk localized prostate cancer.

A joint collective between the AUA, the American Society for Radiation Oncology (ASTRO), and the Society of Urologic Oncology (SUO) has released a new evidence-based clinical guideline for the management of clinically localized prostate cancer.

The guideline divides localized prostate cancer into low-, intermediate-, and high-risk disease.

“It’s been quite some time since the AUA or ASTRO had refreshed the prostate cancer guidelines and there’s been quite a bit of new evidence that’s come along over the last several years. It was important to incorporate the evolution of care standards into the guidelines,” Martin Sanda, MD, of Emory University School of Medicine, Atlanta, who served as the chair of the guideline development panel, told Urology Times. “The guidelines were quite limited in terms of their scope and directionality previously, as well.”

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Over the past 5-6 years, multiple randomized clinical trials have come forward that were not included in the prior version of the guideline. This new guideline has the opportunity to provide a more robust and comprehensive framework so that urologists, radiation oncologists, and oncologists can help ensure a consistent level of care quality for a man with newly diagnosed, localized prostate cancer.

The guideline includes updates on shared decision-making, care options based on cancer severity, and specific care options such as active surveillance, radical prostatectomy, high-intensity focused ultrasound, and focal therapy. Once the collaborators agreed on the guideline, it was passed on to peer reviewers of varying backgrounds before being approved by the AUA, ASTRO, and SUO Board of Directors.

Next: "The inclusion and engaged participation of the panel of radiation oncologists was really key.”

 

“One of the features I think is critical, is the use of an evidence-based approach that recognizes the quality of and the robustness of the clinical studies that form the basis of the guidelines,” Dr. Sanda said. “Another thing that I feel is very important with the guidelines is that it wasn’t limited to urologists. It’s not a urology-alone practice, so the inclusion and engaged participation of the panel of radiation oncologists was really key.”

Among the recommendations made are that active surveillance should serve as the preferred course for low-risk localized prostate cancer, and radical prostatectomy or radiotherapy plus androgen deprivation therapy is best as treatment for patients with intermediate- or high-risk localized disease.

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The guideline offers 68 statements in total, and includes sections on managing side effects and what to expect from various treatment outcomes, including health-related quality of life.

“We wanted to emphasize the importance of clinicians being mindful of and sharing with patients what the realistic expectations would be in terms of side effects and treatments, and that was put forward within the framework of each of the different types of care,” Dr. Sanda said. “We tried to provide some information in the guidelines to facilitate that.”

He added that urologists and physicians taking care of patients with localized prostate cancer are well tuned in to the reality of sexual side effects, as well as urinary, bowel, or hormonal side effects, and one component of the guideline emphasizes attention to those details-not just after the fact, but beforehand in explaining the expectations.

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