Clinical Practice Guidelines for the management of locally advanced ...

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Chapter Recommendations Grade Refs Unsealed radioisotopes alone may be associated with higher haematological adverse events compared with supportive care or localised radiation, although overall these rates are low. Unsealed radioisotopes in combination with other treatments such as radiotherapy have higher rates of serious toxicity than radiotherapy alone. The toxicity of unsealed radioisotopes in combination with modern chemotherapy (taxanes) has not yet been defined and caution should be exercised if such combinations are considered. 6.5 Chemotherapy 6.5.2 Castration-resistant prostate cancer Docetaxel in combination with prednisone is appropriate in the first line setting to improve survival, pain and quality of life in good performance patients with castrate-resistant metastatic prostate cancer. The combination of mitoxantrone and prednisolone also offers palliative benefit but no survival benefit compared to docetaxel. 7. PALLIATIVE CARE 7.4 Decision-making and treatment planning Men with metastatic prostate cancer should be referred for specialist palliative care or a coordinated palliative approach to assist in advance care planning. 7.5 Symptom control Men with metastatic prostate cancer should be referred for interdisciplinary palliative care to assist with symptom control and in providing emotional, social and spiritual support. 7.6End-of-life care Men with metastatic prostate cancer and their families should be referred for a coordinated palliative approach to assist in providing effective end of life care. 8. COMPLEMENTARY AND ALTERNATIVE (UNPROVEN) THERAPIES Ascertaining patient’s use of CAM Health professionals should ask their patients about their use of CAM therapies in a supportive, understanding and non-judgmental way. Calcitriol Calcitriol in combination with docetaxel chemotherapy is not recommended on the basis of a large randomised trial which found excess mortality. xviii C 46-49, 52- 54, 56-59 B C 14,18, 20 62, 63 C 9,11-13 C 7-9,14-16 C 8-13,15- 23, 31, 32 D 4,5 Clinical practice guidelines for the management of locally advanced and metastatic prostate cancer A See reference 12 (mortality alert)
Chapter Recommendations Grade Refs Lycopene Lycopene may benefit a small group of men with metastatic prostate cancer who have had no radiotherapy, no hormone therapy and who have had orchidectomy. In view of these findings, lycopene deserves to be further trialled. Dietary supplements There is insufficient evidence to make any recommendations on dietary supplements in relation to quality of life, pain relief and toxicity. 9. SOCIO-ECONOMIC ASPECTS OF ADVANCED PROSTATE CANCER Socio-economic status and outcomes D Based on a lack of evidence from randomised trials or observational studies, it is not possible to determine whether socio-economic status is associated with differences in outcomes for men with locally advanced or metastatic prostate cancer. C 9 C 9,10,14 Summary of clinical practice recommendations xix
Page 1: Clinical Practice Guidelines for th
Page 4 and 5: 4 Biochemical relapse .............
Page 6 and 7: FOREWORD The management of prostate
Page 8 and 9: SUMMARY OF CLINICAL PRACTICE RECOMM
Page 10 and 11: SUMMARY OF RECOMMENDATIONS Chapter
Page 12 and 13: Chapter Recommendations Grade Refs
Page 20 and 21: 1 INTRODUCTION 1.1 Natural history
Page 22 and 23: 2 PSYCHOSOCIAL CARE The diagnosis a
Page 24 and 25: 2.2 Effect of psychological and cog
Page 26 and 27: Evidence summary Level References T
Page 28 and 29: Recommendation Men with advanced pr
Page 30 and 31: An Australian cross-sectional study
Page 32 and 33: 10. Dunn J, et al. A review of peer
Page 34 and 35: 41. Sharpley CF, Christie DRH. An a
Page 36 and 37: different treatments from different
Page 38 and 39: Evidence summary Level References I
Page 40 and 41: Evidence summary Level References F
Page 42 and 43: Despite these reservations and the
Page 44 and 45: For non-metastatic disease there we
Page 46 and 47: Evidence summary Level References T
Page 48 and 49: monotherapy for low-to-intermediate
Page 50 and 51: Evidence summary Level References M
Page 52 and 53: for surgery, suggesting that surger
Page 54 and 55: Microscopic fully resected node pos
Page 56 and 57: All three trials demonstrated impro
Page 58 and 59: Evidence summary Level References B
Page 60 and 61: of an international multicentre ran
Page 62 and 63: 45. Melton LJ, III, Alothman KI, Kh
Page 64 and 65: 76. Little DJ, Kuban DA, Levy LB, Z
Page 66 and 67: 105. Thompson IM, Tangen CM, Parade
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4.2 Androgen deprivation therapy (e
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Evidence summary Level References F
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therapy since such studies would be
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apparent in trials comparing CAB wi
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QLQ instrument published by Cleary
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Note: Larger well-powered studies h
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Eight trials examined acute toxicit
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half of patients experienced pain r
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olus) in addition to radiotherapy a
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References 1. Seidenfeld J, Samson
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Cooperative Group. Scandinavian Jou
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Oncology Group, TROG 96.05). Radiot
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trial. European Journal of Cancer 1
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6 CASTRATION-RESISTANT PROSTATE CAN
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the median overall survival for pat
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There are two points regarding bisp
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with bone pain at study entry. At n
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Recently, there have been reports o
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of these studies 56, 58 and in the
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Side effects (toxicity) As these ra
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hydrocortisone respectively. Tannoc
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5. Manikandan R, Srirangam SJ, Pear
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33. Elomaa I, Kylmala T, Tammela T
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60. Janknegt RA, Abbou CC, Bartolet
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physiotherapists, occupational ther
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7.5 Q2: Symptom control There was e
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Informal or family caregivers deriv
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8. Hughes SL, Weaver FM, Giobbie-Hu
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8 COMPLEMENTARY AND ALTERNATIVE (UN
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corresponding benefit in obstructiv
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3. Eisenberg DM, Kessler RC, Van Ro
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areas of the state were more likely
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8 Miller DC, Litwin MS, Bergman J,
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10 EMERGING THERAPIES It is impossi
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APPENDIX 1 GUIDELINE DEVELOPMENT PR
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study type. Studies published befor
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Grade of recommendation Description
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2. National Health and Research Cou
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Dr Carole Pinnock AM Principal rese
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Surgery Professor Villis Marshall A
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APPENDIX 3 TNM CLASSIFICATION OF PR
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Summary Prostate T1 T2 T3 T4 N1 M1a
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APPENDIX 4 ABBREVIATIONS AND GLOSSA
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Glossary Actuarial survival A metho
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Effectiveness The extent to which a
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Lymph nodes Small, generally pea-si
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Each stage is divided into subgroup
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APPENDIX 6 - ORGANISATIONS WHICH PR
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Consultant Urologist, Royal Brisban
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No conflict of interest to declare.
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Index to Clinical practice guidelin
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cardiovascular mortality 19, 54, 55
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androgen deprivation therapy (ADT)
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and surgery 32-34 survival 18 toxic
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and chemotherapy 89-90 see also bon
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spinal cord compression 62-63 see a
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systemic 141 Tasmania Association f
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