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 This is an original JCO publication from 2007. Please visit the JCO website to access the full article.

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.






ASCO Guideline Disclaimer: The clinical practice guidelines and other guidance published herein are provided by the American Society of Clinical Oncology, Inc. (“ASCO”) to assist practitioners in clinical decision making. The information therein should not be relied upon as being complete or accurate, nor should it be considered as inclusive of all proper treatments or methods of care or as a statement of the standard of care. With the rapid development of scientific knowledge, new evidence may emerge between the time information is developed and when it is published or read. The information is not continually updated and may not reflect the most recent evidence. The information addresses only the topics specifically identified therein and is not applicable to other interventions, diseases, or stages of diseases. This information does not mandate any particular course of medical care. Further, the information is not intended to substitute for the independent professional judgment of the treating physician, as the information does not account for individual variation among patients. Recommendations reflect high, moderate or low confidence that the recommendation reflects the net effect of a given course of action.  The use of words like “must,” “must not,” “should,” and “should not” indicate that a course of action is recommended or not recommended for either most or many patients, but there is latitude for the treating physician to select other courses of action in individual cases. In all cases, the selected course of action should be considered by the treating physician in the context of treating the individual patient. Use of the information is voluntary.  ASCO provides this information on an “as is” basis, and makes no warranty, express or implied, regarding the information. ASCO specifically disclaims any warranties of merchantability or fitness for a particular use or purpose. ASCO assumes no responsibility for any injury or damage to persons or property arising out of or related to any use of this information or for any errors or omissions.

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