ASCO endorses AUA/ASTRO/SUO guidelines on treatment of localized prostate cancer


We are delighted to note that the American Society of Clinical Oncology (ASCO) has now endorsed 66 of the 68 guidelines issued in April 2017 on the treatment of localized prostate cancer by a joint working group from the American Uriological Association (AUA), the American Society of Radiation Oncology (ASTRO), and the Society for Urologic Oncology (SUO).

The only two of the 68 guidelines not endorsed by ASCO are the two that relate to the use of cryosurgery in the management of localized disease. The published ASCO endorsement by Bekelman et al. (see here) states that:

The two recommendations covering cryosurgery were not endorsed as the panel found that there is insufficient evidence to support the use of cryotherapy in this setting.

These two guidelines were no. 11 and no. 18 in the original AUA/ASTRO/SUO guideline document. Cryosurgeons in the urology community will probably not be too happy about this, but there is a degree of justification for ASCO’s reasoning.

As far as your sitemaster can remember, this is the first time that all four of the major, US-based, specialist medical societies representing physicians who treat prostate cancer have ever pretty much completely concurred on a single set of guidelines for the treatment of any subset of prostate cancer patients.

From that perspective alone, this is a wonderful step in the right direction when it comes to the treatment of localized prostate cancer, and Prostate Cancer International is pleased to see this degree of concurrence between the four organizations. We would like to think that the four organizations will, in the future, continue to collaborate on the development of shared sets of guidance on the management of locally advanced, micrometastatic, and metastatic forms of prostate cancer.

5 Responses

  1. I’m excited about this. It’s great to see that an effort like this has gained great support. This was a great panel of physicians that really listened to me, the patient representative, and took actions in discussion and science. This is a great example of integrating the patients into the discussion and making shared decisions from a different level.

  2. I forwarded to every urologist, radiation oncologist, medical oncologist, and patient for whom I had an e-mail address (a couple hundred) encouraging them to take the time to read this if they had not already received the information themselves.

  3. I am very glad to see that recommendation 44 approves of the precise treatment I got in 2009 to 2012. I will send it to the oncologist in Uppsala who argued strongly for the longest recommended period for adjuvant ADT, 36 months. I got that with combined HDR and EBRT.

    Per 44. I was curious about this, as I know there was a discussion about best duration. Can you recommend some reading about this? One friendly Dutch oncologist told me that, “I hear 18 or 24 months is OK too.”

  4. George:

    There are numerous commentaries and related articles on this site about the length of time someone who gets adjuvant ADT along with radiation therapy should be on the ADT. Here are links to some of them. Basically, where we stand today is that a man who has high-risk prostate cancer and who gets ADT together with the radiation should probably start the ADT about 3 months prior to starting the radiation and should be on the ADT for 18 months but in most cases no longer than 3 years.

    For men with intermediate-risk forms of prostate cancer the question of whether the patients needs ADT at all is more complex but 18 months would certainly appear to be enough and it is possible that a mere 6 months would be sufficient if ADT is thought to be necessary.

  5. Dear Sitemaster:

    Thanks, I will look at them.

    I did get 3 months of neoadjuvant ADT. If memory serves it was Casodex + Zoladex. And then concurrent Zoladex.

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