ESMO updates prostate cancer guidelines

  • European Society for Medical Oncology
  • 2 Apr 2019

  • Oncology guidelines update
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Takeaway

  • The European Society for Medical Oncology (ESMO) has issued an update to its 2015 guidelines for the treatment of prostate cancer:
    • Prostate radiotherapy, in addition to standard systemic treatment, is recommended in patients with newly diagnosed, low-burden metastatic prostate cancer.
    • Combining abiraterone acetate plus prednisone or prednisolone (AAP) and radium-223 is not recommended in patients with metastatic castration-resistant prostate cancer (mCRPC).

Key updates

  • Management of advanced/metastatic disease: offer prostate radiotherapy in addition to standard systemic treatment in patients with newly diagnosed low-burden disease.
    • The recommendation is based on STAMPEDE and HORRAD trials.
    • In STAMPEDE trial: radiotherapy improved OS (from 73% to 81% at 3 years) in patients with a low metastatic burden.
    • Meta-analysis of the 2 trials showed 7% improvement in OS with concurrent prostate radiotherapy in addition to androgen deprivation therapy (ADT) in patients with
  • Treatment of mCRPC: do not offer combination of AAP and radium-223; consider bone protective agents to prevent fractures.
    • Double-blind, placebo-controlled phase 3 ERA 223 trial: addition of radium-223 to AAP failed to improve symptomatic skeletal-related event-free survival and increased incidence of bone fractures.