ASCO Endorsement of the CCO Practice Guideline on Non-Hormonal Therapy for Men With Metastatic Hormone-Refractory (castration-resistant) Prostate Cancer
For men with clinical or biochemical evidence of progression and evidence of metastases, treatment with docetaxel 75 mg/m2administered intravenously every 3 weeks with 5 mg oral prednisone twice daily should be offered to improve overall survival, disease control, symptom palliation, and quality of life.
Alternative therapies that have not demonstrated improvement in overall survival but can provide disease control, palliation, and improve quality of life include weekly docetaxel plus prednisone, and mitoxantrone plus prednisone (or hydrocortisone).
Docetaxel-based chemotherapy is the only treatment that has demonstrated an overall survival benefit in men with hormone-refractory prostate cancer.
The timing of docetaxel therapy in men with evidence of metastases but without symptoms should be discussed with patients and individualized based on their clinical status and preferences.
In the largest clinical trials reviewed for this guideline, the men enrolled continued on gonadal androgen suppression and discontinued the use of antiandrogens. These maneuvers are recommended for men with hormone-refractory prostate cancer who receive chemotherapy.
Men with hormone-refractory prostate cancer should have symptom control optimized.
Use of estramustine in combination with other cytotoxic agents is not recommended due to the increased risk of clinically important toxicities without evidence of improved survival or palliation.
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