ASCO Endorses Localized Prostate Cancer Guideline

A panel of experts at the American Society of Clinical Oncology (ASCO) have reviewed and endorsed Cancer Care Ontario’s guideline on Active Surveillance for the Management of Localized Prostate Cancer. They are published in the Journal of Clinical Oncology.

The guidelines, published in May 2015, “are clear, thorough, and based upon the most relevant scientific evidence,” wrote Ronald C. Chen, MD, MPH, associate professor in the department of radiation oncology at UNC-Chapel Hill, and coauthors. ASCO endorsed all aspects of the guideline except for the recommendation on use of 5-alpha reductase inhibitors.

Key Recommendations

• Factors including younger age, prostate cancer volume, patient preference, and ethnicity should be taken into account when making management decisions.

• For most patients with low-risk localized prostate cancer (Gleason score ≤ 6), active surveillance is the recommended disease management strategy.

• Select patients with low-volume, intermediate-risk prostate cancer (Gleason 3 + 4 = 7) may be offered active surveillance.

• Active surveillance protocols should include prostate-specific antigen (PSA) testing, digital rectal examinations, and serial prostate biopsies.

• Ancillary radiologic and genomic tests are investigational but may have a role in patients with discordant clinical and/or pathologic findings.

• Patients who are reclassified to a higher-risk category (Gleason score of 7 or greater) or who have significant increases in tumor volume on subsequent biopsies should be offered active therapy.

On the role of 5-alpha reductase inhibitors, Cancer Care Ontario’s guideline states that these agents may have a role in men receiving active surveillance. The US Food and Drug Administration, however, has issued a warning about the low possibility of an increased risk for high-grade prostate cancer with the use of 5-alpha reductase inhibitors. The Cancer Care Ontario expert panel stated that the benefits of these inhibitors outweigh the risk, but the ASCO panel did not endorse these recommendations.

According to the Cancer Care Ontario guideline, there is currently not enough evidence to make recommendations on which clinicians should manage active surveillance. The ASCO prostate cancer endorsement panel agreed with this and added that “a multidisciplinary team approach should be taken when a change to active treatment is considered.”