GuidelinesEAU Guidelines on Prostate Cancer. Part II: Treatment of Advanced, Relapsing, and Castration-Resistant Prostate Cancer☆
Introduction
The most recent summary of the European Association of Urology (EAU) guidelines on PCa was published in 2008 [1]. This paper summarises the 2010 update of the EAU guidelines on the treatment of advanced, relapsing, and castration-resistant PCa (CRPC). The guidelines on screening, diagnosis, and treatment of clinically localised PCa have been published in a separate paper. To facilitate evaluating the quality of the information provided, we inserted LEs and GR according to a modified classification system from the Oxford Centre for Evidence-Based Medicine levels of evidence [2].
Section snippets
Luteinising hormone-releasing hormone: analogues and antagonists
Luteinising hormone-releasing hormone (LHRH) agonists have become the standard of care in hormonal therapy because these agents:
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Have the potential for reversibility and enable the use of IAD therapy.
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Avoid the physical and psychological discomfort associated with orchiectomy.
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Have a lower risk of cardiotoxicity as observed with diethylstilbestrol.
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Result in equivalent oncologic efficacy [3], [4].
In contrast to the agonists, LHRH antagonists result in a rapid decrease in luteinising hormone,
Definition of recurrence
Following RP, a confirmed PSA value >0.2 ng/ml (ie, two consecutive increases) represents recurrent cancer [38]. Following radiation therapy (RT), a PSA value of 2 ng/ml above the nadir after RT represents recurrent cancer [39].
Local failure following RP might be predicted with an 80% probability by a PSA increase >3 yr after RP, a PSA DT >11 mo, a Gleason score <7, and stage ≤pT3a pN0, pTx R1. Systemic failure following RP might be predicted with >80% accuracy by a PSA increase <1 yr after RP,
Summary
The present text represents a summary, and for more detailed information and a full list of references, refer to the full-text version. These EAU guidelines (ISBN 978-90-79754-70-0) are available on the EAU Web site (http://www.uroweb.org/guidelines/online-guidelines/).
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