EAU Guidelines on Prostate Cancer. Part II: Treatment of Advanced, Relapsing, and Castration-Resistant Prostate Cancer
Mottet, Nicolas × Bellmunt, Joaquim Bolla, Michel Joniau, Steven Mason, Malcolm Matveev, Vsevolod Schmid, Hans-Peter Van der Kwast, Theo Wiegel, Thomas Zattoni, Filiberto Heidenreich, Axel #
European Urology vol:59 issue:4 pages:572-583
Objectives: Our aim is to present a summary of the 2010 version of the European Association of Urology (EAU) guidelines on the treatment of advanced, relapsing, and castration-resistant prostate cancer (CRPC).
Methods: The working panel performed a literature review of the new data emerging from 2007 to 2010. The guidelines were updated, and the levels of evidence (LEs) and/or grades of recommendation (GR) were added to the text based
on a systematic review of the literature, which included a search of online databases and bibliographic reviews.
Results: Luteinising hormone-releasing hormone (LHRH) agonists are the standard of care in metastatic prostate cancer (PCa). Although LHRH antagonists decrease
testosterone without any testosterone surge, their clinical benefit remains to be determined. Complete androgen blockade has a small survival benefit of about 5%.
Intermittent androgen deprivation (IAD) results in equivalent oncologic efficacy when compared with continuous androgen-deprivation therapy (ADT) in wellselected
populations. In locally advanced and metastatic PCa, early ADT does not result in a significant survival advantage when comparedwith delayed ADT. Relapse after local therapy is defined by prostate-specific antigen (PSA) values >0.2 ng/ml following radical prostatectomy (RP) and >2 ng/ml above the nadir after radiation therapy (RT). Therapy for PSA relapse after RP includes salvage RT at PSA levels
<0.5 ng/ml and salvage RP or cryosurgical ablation of the prostate in radiation