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

CONTENTS
Foreword ............................................................................................................................................... vi
Preface ................................................................................................................................................ vii
Summary of clinical practice recommendations ............................................................................ viii
Summary of recommendations ............................................................................................................ x
1 Introduction .............................................................................................................................. 1
1.1 Natural history and staging of prostate cancer .............................................................. 1
1.2 Prostate cancer in Australia .......................................................................................... 1
2 Psychosocial care ...................................................................................................................... 3
2.1 Effect of interventions to improve decision satisfaction, risk comprehension,
knowledge about prostate cancer and understanding about prognosis ......................... 3
2.2 Effect of psychological and cognitive interventions on psychosocial
adjustment ..................................................................................................................... 5
2.3 Effect of diet and lifestyle interventions on quality of life ........................................... 7
2.4 Effect of sexual functioning interventions .................................................................... 9
2.5 Effect of interventions to alleviate partner distress ..................................................... 10
2.6 Depression and anxiety ............................................................................................... 10
3 Locally advanced disease
(Locally advanced/high-risk prostate cancer—de novo presentation (clinical
stage T3–4, and/or early-stage disease with PSA>20) ......................................................... 16
3.1 Introduction ............................................................................................................... 16
3.1.1 Androgen deprivation therapy (ADT) ........................................................... 16
3.1.2 Radiotherapy .................................................................................................. 24
3.1.3 Radiotherapy and androgen deprivation therapy ........................................... 29
3.1.4 Surgery ........................................................................................................... 31
3.1.5 Surgery plus androgen deprivation therapy ................................................... 32
3.1.6 Chemotherapy ................................................................................................ 34
3.1.7 Bisphosphonates ............................................................................................ 34
3.2. Pathologic T3/T4 disease post radical surgery (Patients with extra capsular
extension, seminal vesicle involvement or positive surgical margins) ....................... 34
3.2.1 Adjuvant external beam radiotherapy ............................................................ 34
3.2.2 Adjuvant systemic chemotherapy .................................................................. 36
3.2.3 Adjuvant androgen deprivation therapy ........................................................ 36
3.3 Node positive disease .................................................................................................. 36
3.3.1 Radiotherapy and adjuvant androgen deprivation therapy ............................ 36
3.3.2 External beam radiotherapy ........................................................................... 37
Contents iii