EURURO Vol. 71 No. 4

Guidelines

EAU-ESTRO-SIOG Guidelines on Prostate Cancer. Part II:

Treatment of Relapsing, Metastatic, and Castration-Resistant

Prostate Cancer

Philip Cornford

a , * ,

Joaquim Bellmunt

b , c ,

Michel Bolla

d ,

Erik Briers

e ,

Maria De Santis

f ,

Tobias Gross

g ,

Ann M. Henry

h ,

Steven Joniau

i ,

Thomas B. Lam

j , k ,

Malcolm D. Mason

l ,

Henk G. van der Poel

m ,

Theo H. van der Kwast

n ,

Olivier Rouvie`re

o ,

Thomas Wiegel

p ,

Nicolas Mottet

Royal Liverpool and Broadgreen Hospitals NHS Trust, Liverpool, UK;

Bladder Cancer Center, Dana-Farber Cancer Institute, Boston, MA, USA;

Harvard

Medical School, Boston, MA, USA;

Department of Radiation Therapy, CHU Grenoble, Grenoble, France;

Patient Advocate, Hasselt, Belgium;

University of

Warwick, Cancer Research Centre, Coventry, UK;

Department of Urology, University of Bern, Inselspital, Bern, Switzerland;

Leeds Cancer Centre, St. James’s

University Hospital, Leeds, UK;

Department of Urology, University Hospitals Leuven, Leuven, Belgium;

Academic Urology Unit, University of Aberdeen,

Aberdeen, UK;

Department of Urology, Aberdeen Royal Infirmary, Aberdeen, UK;

Velindre Hospital, Cardiff, UK;

Department of Urology, Netherlands

Cancer Institute, Amsterdam, The Netherlands;

Department of Pathology, Erasmus Medical Centre, Rotterdam, The Netherlands;

Hospices Civils de Lyon,

Radiology Department, Edouard Herriot Hospital, Lyon, France;

Department of Radiation Oncology, University Hospital Ulm, Ulm, Germany;

Department

of Urology, University Hospital, St. Etienne, France

E U R O P E A N U R O L O G Y 7 1 ( 2 0 1 7 ) 6 3 0 – 6 4 2

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Article info

Article history:

Accepted August 2, 2016

Associate Editor:

James Catto

Keywords:

Prostate cancer

Staging

Relapse

Metastatic

Castration-resistant

EAU-ESTRO-SIOG Guidelines

Hormonal therapy

Chemotherapy

Follow-up

Palliative

Abstract

Objective:

To present a summary of the 2016 version of the European Association of

Urology (EAU) – European Society for Radiotherapy & Oncology (ESTRO) – International

Society of Geriatric Oncology (SIOG) Guidelines on the treatment of relapsing, meta-

static, and castration-resistant prostate cancer (CRPC).

Evidence acquisition:

The working panel performed a literature review of the new data

(2013–2015). The guidelines were updated, and the levels of evidence and/or grades of

recommendation were added based on a systematic review of the literature.

Evidence synthesis:

Relapse after local therapy is defined by a rising prostate-specific

antigen (PSA) level

0.2 ng/ml following radical prostatectomy (RP) and

2 ng/ml above

the nadir after radiation therapy (RT).

C-choline positron emission tomography/

computed tomography is of limited importance if PSA is

1.0 ng/ml; bone scans and

computed tomography can be omitted unless PSA is

10 ng/ml. Multiparametric

magnetic resonance imaging and biopsy are important to assess biochemical failure

following RT. Therapy for PSA relapse after RP includes salvage RT at PSA levels

0.5 ng/

ml and salvage RP, high-intensity focused ultrasound, cryosurgical ablation or salvage

brachytherapy of the prostate in radiation failures. Androgen deprivation therapy (ADT)

remains the basis for treatment of men with metastatic prostate cancer (PCa). However,

docetaxel combined with ADT should be considered the standard of care for men with

metastases at first presentation, provided they are fit enough to receive the drug. Follow-

up of ADT should include analysis of PSA, testosterone levels, and screening for

cardiovascular disease and metabolic syndrome. Level 1 evidence for the treatment

of metastatic CRPC (mCRPC) includes, abiraterone acetate plus prednisone (AA/P),

enzalutamide, radium 223 (Ra 223), docetaxel at 75 mg/m

every 3 wk and sipuleu-

cel-T. Cabazitaxel, AA/P, enzalutamide, and radium are approved for second-line

* Corresponding author. Royal Liverpool and Broadgreen Hospitals NHS Trust, Department of

Urology, Prescott Street, Liverpool L7 8XP, UK. Tel. +44 15 17 06 3594; Fax: +44 15 17 06 53 10.

E-mail address:

Philip.Cornford@rlbuht.nhs.uk

(P. Cornford).

http://dx.doi.org/10.1016/j.eururo.2016.08.002

0302-2838/