NEW AUA Guidelines for Castration-Resistant Prostate Cancer

During the 2013 Annual Meeting of the American Urological Association, new guidelines for the treatment of Castration-Resistant Prostate Cancer (CRPC).  CRPC has always been a vexing problem to Urologists since Hormone Therapy was developed by Charles Huggins in 1941.  Although quite effective initially, especially for advanced prostate cancer, it had been found that castration or hormone ablation gradually became less effective after several years, and thus the identification of "Hormone-Resistant Prostate Cancer (HRPC)" made.

In recent years, it has been found that HRPC was found to still be quite sensitive to other forms of hormone therapy, in particular, those that interrupt the steroid synthesis pathway at a "higher" level compared to medical or surgical castration.  This also explains why second-line hormone therapies such as estrogens and ketoconazole was found to be somewhat effective. Thus, the term "Castration-Resistant Prostate Cancer" came into being.

With the development of novel new therapies that are still hormonal in nature, the AUA has now released treatment guidelines that focus on six (typical) "index" patients.  These include:

1. Index Patient 1: Asymptomatic, non-metastatic CRPC
2. Index Patient 2: Asymptomatic or minimally symptomatic, mCRPC without prior docetaxel chemotherapy
3. Index Patient 3: Symptomatic, mCRPC with good performance status and no prior chemotherapy
4. Index Patient 4: Symptomatic, mCRPC with poor performance status and no prior docetaxel chemotherapy
5. Patient 5: Symptomatic, mCRPC with good performance status and prior doxetaxel chemotherapy
6. Index Patient 6: Symptomatic, mCRPC with poor performance status and prior docetaxel chemotherapy

Many clinicians have recognized the importance of releasing such guidelines as in the past, there was lack of cohesion in what exactly would be the best course for these groups of patients.  Most of the time, clinicians would have to wade through tons of research material or attend special symposiums to get some degree of clarity... only to be debunked a few months later.

"Prior to 2004, once patients failed primary androgen deprivation, treatments were administered solely for palliation,"

To read the full text fo the guidelines, visit the website of the American Urological Association or click here.