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

More documents

Recommendations

Info

1 INTRODUCTION 1.1 Natural history and staging of prostate cancer Prostate cancer has many uncertainties associated with its management. A major problem for any review at present arises from the difficulty in establishing with certainty that the cancer is confined to the prostate at the time of diagnosis. Currently, through a combination of PSA measurement and ultra-sound-guided biopsy, it is now possible to establish with greater certainty than before the local extent of the cancer within the gland and its likely aggressiveness by application of the Gleason scoring system. This information, when incorporated with other measurable factors into nomograms, has enabled clinicians to establish the probability but not the certainty of the cancer being confined to the prostate. Before the introduction of PSA it was easier to be certain that a person had metastatic disease on the basis of a positive bone scan or computed tomography (CT). Unfortunately, while the bone scan has a high level of specificity its sensitivity is too low and in current prostate cancer management, bone scans have little use in determining the presence of metastatic disease. Consequently, after presumed curative treatment for local disease, a rising PSA is now used as a surrogate marker for metastatic disease. There is urgent need for a more sensitive and specific test to predict the metastatic potential of an individual cancer. This review initially intended to focus on metastatic disease, but for the reasons outlined above the scope was expanded to include locally advanced as well as metastatic cancer. It is acknowledged that it is often difficult to establish from published articles whether the disease was locally advanced or metastatic because of the ‘grey zone’ resulting from the imprecision of our current staging modalities. Locally-advanced disease for the purpose of the review has been defined as T3/T4 and/or early-stage disease with PSA greater than 20. 1.2 Prostate cancer in Australia The Australian Institute of Health and Welfare (2008) report 1 based on 2005 data predicted that the risk of a male being diagnosed with cancer before age 75 was one in three and before age 85 was one in two. Given that 29% of male cancers arise from the prostate, and assuming a relatively constant pattern of the incidence of cancers as men age, prostate cancer is likely to continue to be a major male health issue as our population ages. We know that approximately 3000 men die each year from prostate cancer 2 and while earlier diagnosis and more aggressive local therapy have been available for at least a decade, the death rate has not declined greatly. The age-standardised mortality rate in 1999 was 35 deaths per 100,000 males and in 2005 was 32.8 deaths per 100,000 males. It is also worthy of note that 84% of deaths from prostate cancer in 2003 occurred in men over the age of seventy. It is therefore evident that for the foreseeable future we will continue to need to care for a significant number of older men with metastatic disease. A cure for metastatic cancer would be the ideal but seems unlikely in the short term. The middle ground is to try to ensure the information currently available is used appropriately to achieve optimal cancer control for these men while preserving the best quality of life. The development of these guidelines is one step in trying to achieve this goal. As part of the original plan no systematic review of evidence took place after (April) 2006. We recognised that this is a limitation of the guidelines. We also recognised that there will need to be a prolonged period of consultation as part of the process of acceptance of guidelines by the NHMRC and this will add to the time between the end of the review and the final publication of the guidelines. To try to in part to address this issue, we noted and provided references for high quality randomised controlled trials where the review team believed that this more contemporary information may cause 1 Introduction
clinicians to reflect on the interpretation and relevance of the recommendations, given that the recommendations were all based on the systematic review of the evidence available as of April 2006. Another important consideration is the significant change in the way medicine is practised, with a much greater focus on informed and shared decision making. The development of these guidelines has provided the evidence base for the production of a consumer guide that will facilitate shared decision making as men and their families confront the health issues associated with the management of advanced and metastatic prostate cancer. References 1 Australian Institute of Health and Welfare. Australian cancer incidence statistics update December 2008. Canberra, AIHW. 2 Australian Institute of Health and Welfare. Cancer an overview 2006. Cancer series number 37. 2007. Canberra, AIHW. Clinical practice guidelines for the management of locally advanced and metastatic prostate cancer 2
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 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
Page 68 and 69: 4.2 Androgen deprivation therapy (e
Page 70 and 71:
Evidence summary Level References F
Page 72 and 73:
therapy since such studies would be
Page 74 and 75:
apparent in trials comparing CAB wi
Page 76 and 77:
QLQ instrument published by Cleary
Page 78 and 79:
Note: Larger well-powered studies h
Page 80 and 81:
Eight trials examined acute toxicit
Page 82 and 83:
half of patients experienced pain r
Page 84 and 85:
olus) in addition to radiotherapy a
Page 86 and 87:
References 1. Seidenfeld J, Samson
Page 88 and 89:
Cooperative Group. Scandinavian Jou
Page 90 and 91:
Oncology Group, TROG 96.05). Radiot
Page 92 and 93:
trial. European Journal of Cancer 1
Page 94 and 95:
6 CASTRATION-RESISTANT PROSTATE CAN
Page 96 and 97:
the median overall survival for pat
Page 98 and 99:
There are two points regarding bisp
Page 100 and 101:
with bone pain at study entry. At n
Page 102 and 103:
Recently, there have been reports o
Page 104 and 105:
of these studies 56, 58 and in the
Page 106 and 107:
Side effects (toxicity) As these ra
Page 108 and 109:
hydrocortisone respectively. Tannoc
Page 110 and 111:
5. Manikandan R, Srirangam SJ, Pear
Page 112 and 113:
33. Elomaa I, Kylmala T, Tammela T
Page 114 and 115:
60. Janknegt RA, Abbou CC, Bartolet
Page 116 and 117:
physiotherapists, occupational ther
Page 118 and 119:
7.5 Q2: Symptom control There was e
Page 120 and 121:
Informal or family caregivers deriv
Page 122 and 123:
8. Hughes SL, Weaver FM, Giobbie-Hu
Page 124 and 125:
8 COMPLEMENTARY AND ALTERNATIVE (UN
Page 126 and 127:
corresponding benefit in obstructiv
Page 128 and 129:
3. Eisenberg DM, Kessler RC, Van Ro
Page 130 and 131:
areas of the state were more likely
Page 132 and 133:
8 Miller DC, Litwin MS, Bergman J,
Page 134 and 135:
10 EMERGING THERAPIES It is impossi
Page 136 and 137:
APPENDIX 1 GUIDELINE DEVELOPMENT PR
Page 138 and 139:
study type. Studies published befor
Page 140 and 141:
Grade of recommendation Description
Page 142 and 143:
2. National Health and Research Cou
Page 144 and 145:
Dr Carole Pinnock AM Principal rese
Page 146 and 147:
Surgery Professor Villis Marshall A
Page 148 and 149:
APPENDIX 3 TNM CLASSIFICATION OF PR
Page 150 and 151:
Summary Prostate T1 T2 T3 T4 N1 M1a
Page 152 and 153:
APPENDIX 4 ABBREVIATIONS AND GLOSSA
Page 154 and 155:
Glossary Actuarial survival A metho
Page 156 and 157:
Effectiveness The extent to which a
Page 158 and 159:
Lymph nodes Small, generally pea-si
Page 160 and 161:
Each stage is divided into subgroup
Page 162 and 163:
APPENDIX 6 - ORGANISATIONS WHICH PR
Page 164 and 165:
Consultant Urologist, Royal Brisban
Page 166 and 167:
No conflict of interest to declare.
Page 168 and 169:
Index to Clinical practice guidelin
Page 170 and 171:
cardiovascular mortality 19, 54, 55
Page 172 and 173:
androgen deprivation therapy (ADT)
Page 174 and 175:
and surgery 32-34 survival 18 toxic
Page 176 and 177:
and chemotherapy 89-90 see also bon
Page 178 and 179:
spinal cord compression 62-63 see a
Page 180 and 181:
systemic 141 Tasmania Association f
show all

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

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?