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Practice Guideline
. 2021 Apr 10;39(11):1274-1305.
doi: 10.1200/JCO.20.03256. Epub 2021 Jan 26.

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

Katherine S Virgo  1 , R Bryan Rumble  2 , Ronald de Wit  3 , David S Mendelson  4 , Thomas J Smith  5 , Mary-Ellen Taplin  6 , James L Wade 3rd  7 , Charles L Bennett  8 , Howard I Scher  9 , Paul L Nguyen  6 , Martin Gleave  10 , Scott C Morgan  11 , Andrew Loblaw  12 , Sean Sachdev  13 , David L Graham  14 , Neha Vapiwala  15 , Amy M Sion  16 , Virgil H Simons  17 , James Talcott  18
Affiliations
Practice Guideline

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

Katherine S Virgo et al. J Clin Oncol. .

Abstract

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

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

Results: 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.

Recommendations: 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.

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Conflict of interest statement

Reprint Requests: 2318 Mill Road, Suite 800, Alexandria, VA 22314; guidelines@asco.org Ronald de Wit Honoraria : Sanofi, Merck Sharp & Dohme Consulting or Advisory Role: Sanofi, Merck Sharp & Dohme, Roche/Genentech, Janssen, Bayer, Astellas Pharma Research Funding: Sanofi, Bayer Thomas J. Smith Honoraria: Athenex, Association of Community Cancer Centers (ACCC) Patents, Royalties, Other Intellectual Property: Royalties from Oxford Textbook of Cancer Communication, co-editor. Open Payments Link: https://openpaymentsdata.cms.gov/physician/202382/general-payments Mary-Ellen Taplin Honoraria: Janssen-Ortho, Clovis Oncology, Astellas Pharma, Incyte, UpToDate, Research to Practice, Pfizer, Bayer, Amgen, AstraZeneca, Progenics, Guidepoint Global, Celgene, Merck, GlaxoSmithKline, Myovant Sciences, Roivant, Pfizer, Abbvie, Arcus Biosciences, Constellation Pharmaceuticals Consulting or Advisory Role: Janssen-Ortho, Bayer, Guidepoint Global, Best Doctors, Inc, UpToDate, Clovis Oncology, Research to Practice, Myovant Sciences, Incyte, Pfizer, AstraZeneca, Arcus Ventures Research Funding: Janssen-Ortho, Medivation, Bayer, Pfizer Travel, Accommodations, Expenses: Medivation, Janssen Oncology, Tokai Pharmaceuticals, Astellas Pharma, Incyte, Pfizer, Clovis Oncology, Bayer James L. Wade III Employment: Johnson & Johnson Stock and Other Ownership Interests: Celgene, Abbott, GlaxoSmithKline, Johnson & Johnson, Novartis Consulting or Advisory Role: New Century Health Charles L. Bennett Consulting or Advisory Role: Oncology Analytics Research Funding: Pharmacyclics/Janssen Howard I. Scher Leadership: Asterias Biotherapeutics Stock and Other Ownership Interests: Asterias Biotherapeutics Honoraria: Research to Practice Consulting or Advisory Role: Janssen Biotech, Inc, Amgen, Janssen Research & Development, Menarini Silicon Biosystems, WIRB-Copernicus Group, ESSA, Ambry Genetics Corporation, Konica Minolta, Inc, Pfizer, Bayer Research Funding: Janssen, Illumina, Epic Sciences, Menarini Silicon Biosystems, Thermofisher Scientific Biomarkers Patents, Royalties, Other Intellectual Property: BioNTech—Intellectual Property Rights, Elucida Oncology—Intellectual Property Rights, MabVAX—Intellectual Property Rights, Y-mAbs Therapeutics, Inc—Intellectual Property Rights Travel, Accommodations, Expenses: Asterias Biotherapeutics, Menarini Silicon Biosystems, Amgen, WIRB-Copernicus Group, Konica Minolta, Inc, ESSA, Prostate Cancer Foundation, Sanofi, Bayer, Phosplatin Therapeutics Paul L. Nguyen Stock and Other Ownership Interests: Volatilyx, Augmenix Consulting or Advisory Role: Medivation, GenomeDx, Ferring, Nanobiotix, Dendreon, Augmenix, GigaGen, Biogen, Bayer, Astellas Pharma, Blue Earth Diagnostics, Augmenix, Coda, Boston Scientific, Janssen Oncology Research Funding: Astellas Pharma, Nanobiotix, Janssen, Wako Diagnostics, Bayer Patents, Royalties, Other Intellectual Property: Wife has a patent on volatile diagnostics of infections Travel, Accommodations, Expenses: Ferring Martin Gleave Stock and Other Ownership: OncoGenex Honoraria: Janssen, Astellas Pharma, Bayer, Sanofi, GDx, Pfizer, Tersera, Roche Consulting or Advisory Role: Janssen, Astellas Pharma, Bayer, Sanofi, AstraZeneca, GDx, Pfizer, Tersera, Roche Research Funding: Janssen, Astellas Pharma, Bayer Patents, Royalties, Other Intellectual Property: OncoGenex—OGX-011, OGX-427, ST-CP, ST-POP Scott C. Morgan Consulting or Advisory Role: Astellas Pharma, Bayer, Janssen, Tersera Andrew Loblaw Honoraria: Janssen Oncology, Astellas Pharma, Abbvie, Bayer, Sanofi Canada, Tersera Consulting or Advisory Role: Janssen Oncology, Abbvie, Bayer, TerSera, Sanofi Canada, Astellas Pharma Research Funding: Tersera Patents, Royalties, Other Intellectual Property: Prostate immobilization device (GU-Lok) Travel, Accommodations, Expenses: Janssen Oncology, Astellas Pharma, Tersera, Sanofi Canada David L. Graham Speakers' Bureau: Biopep Solution Neha Vapiwala Consulting or Advisory Role: Magellan HealthRx Amy M. Sion Stock and Other Ownership Interests: Seattle Genetics, Abbvie, Merck Honoraria: Merck James Talcott Employment: NantHealth Open Payments Link: https://openpaymentsdata.cms.gov/physician/1242101No other potential conflicts of interest were reported.

Comment in

  • Metastatic Prostate Cancer: In Search of More Granularity.
    Tewari AK, Gillessen S, Sweeney CJ. Tewari AK, et al. J Clin Oncol. 2021 Sep 10;39(26):2968-2969. doi: 10.1200/JCO.21.00643. Epub 2021 May 14. J Clin Oncol. 2021. PMID: 33989011 No abstract available.
  • Reply to A. K. Tewari et al.
    Talcott JA, Virgo KS. Talcott JA, et al. J Clin Oncol. 2021 Sep 10;39(26):2969-2970. doi: 10.1200/JCO.21.00753. Epub 2021 May 14. J Clin Oncol. 2021. PMID: 33989012 No abstract available.

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