American Urological Association Advanced Prostate Cancer Guidelines

[Tall_Allen]

No surprises here (at least not for me). I might quibble about the GRADEs on a couple of them, but overall, a good standard-of-care document.

auanet.org/guidelines/advan...

[Dostoevsky]

Good work big guy. Keepin me straight.

[treedown]

Thanks for posting this I have literally been wondering about this since my MO recently said Lupron is the only LHRH agonist my insurance would pay for as SOC. However, others are listed in NCCN Guidelines which I thought was the source of SOC since he referred to it in our first visit. It made me wonder if the insurance company dictates SOC for its customers. I look forward to reading it later.

[Tall_Allen in reply to treedown]

Insurance companies aren't required to provide all FDA-approved medicines.

[DeanNelson in reply to Tall_Allen]

Your are just amazing

[Ahk1]

Thanks, TA for the post.

I have a question please on the following section:

“Biochemical Recurrence without Metastatic Disease after Exhaustion of Local”

The Treatment Options considering ADT:

“ADT should not be routinely initiated in this population (Expert Opinion). However, if ADT is initiated in the absence of metastatic disease, intermittent ADT may be offered in lieu of continuous ADT. (Conditional Recommendation; Evidence Level: Grade B)”

I think I am in this category, do you agree that ADT should not be routinely initiated in this setting?

Thanks

[Tall_Allen in reply to Ahk1]

This is one I would quibble with. I think the stress is on the word "routinely," and they do not give it a strong recommendation ("Expert Opinion" means they don't really have good evidence) If you follow the detailed discussion, they discuss the TOAD trial. That's why they make the point about "intermittent" ADT - ⅔ of the recurrent men in the TOAD trial were put on intermittent ADT. They give it Grade B because the trial did not recruit the expected number of participants. I think it has to be carefully considered. Men who had low Gleason score, a long time as undetctable, and low PSADT probably will do just as well delaying ADT. Men who had high pathology Gleason score, became recurrent soon or had persistent PSA after treatment, and had high PSADT will probably do better with immediate intermittent ADT. But that's just my opinion.

[Ahk1 in reply to Tall_Allen]

Thank you, sir for your answer. I have been struggling to make the decision of starting IADT now or later and have not settled on this one yet but I do appreciate your thoughts.

[Lyubov]

Thanks so much!

[treedown]

Ok I couldn't wait. This:

18. Clinicians should not offer oral androgen pathway directed therapy (e.g., abiraterone acetate plus prednisone, apalutamide, bicalutamide, darolutomide, enzalutamide, flutamide, nilutamide) without ADT for patients with mHSPC. (Expert Opinion)

is not what I am getting and I understand it is weighted as Expert Opinion but doesn't seem to go with what other info I have received. Does the AUA SOC differ from Oncological SOC?

[Tall_Allen in reply to treedown]

This is standard. Lupron (or similar) is always given together with other hormone therapies. The use of, say, abiraterone alone without Lupron is experimental. Based on your profile, you are not in this category (mHSPC). You are N1 (iliac LN), not M1. You also had adjuvant abiraterone + Lupron (an experimental combination) as an adjuvant treatment along with your primary EBRT treatment. None of this applies to you.

[treedown in reply to Tall_Allen]

Thank you for the clarification, it is always appreciated.

[Fiddler2004]

Thanks for posting this, very important piece of information for both clinicians and patients.

[Boacan]

Thanks TA for sharing! The surgeon who performed my RALP is a member of the panel setting these guidelines.

[garyi]

Excellent report....thanks Allen.

[Newyork6264]

Very helpful. Thank you.

[Hidden]

Thanks for this TA. Great summary! I hope my clueless urologist -- the one I got rid of in favor of a medical oncologist -- reads this. The oncologist added apalutamide to the Eligard and had me down to almost undetectable PSA (0.2 in Canada) in two months. I haven't got the results from the latest blood test from a few days ago but I'm hoping I crossed the great PSA divide into undetectable. Cheers!

[tallguy2]

Thanks for posting this. Another good document to have on file!

[j-o-h-n]

They forgot to mention, if this report for men or for women with prostate issues?

T-h-a-n-k-s

Good Luck, GoodHealth and Good Humor.

j-o-h-n Sunday 06/28/2020 5:51 PM DST

[Wings-of-Eagles]

Thanks Allen,

I just saw this posted by Tony Crispino also. Lots of great synopsis/ consensus/conclusions/recommendations if those are the terms to use. Its little hard for me to place my particular case in the right scenario, I am in the MCR category and recommendation #25 to have detailed PET scans yearly is one item that I think aplies, but my Onc Doc said when I start feeling pain they will order the next one(Its been five years) Maybe I could e-mail you my entire one page Dx report from 2012?? I never quite revealed that on that other site or to most anyone really.

If you had any extra time, my brief summary is I had quite a heavy Dx; PSA was 71, Stage 4 with four detectable bone mets, and with three of the ten core samples Gl 7, 4+3 with 70%-83% involvement, and one was Gl 3+4 =7 with 80% involvement . (six core samples were benign) In 2012 I was "given" a prognosis of 3-5 years. But I breezed thru that already!!

Wings aka Dan