Zoledronic acid and denosumab can be used in men with mCRPC and osseous metastases to prevent skeletal-related complications .
PATIENT SUMMARY In men with a rise in their PSA levels after prior local treatment for prostate cancer only , it is important to balance overtreatment against further progression of the disease since survival and quality of life may never be affected in many of these patients .
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 , metastatic , and castration-resistant prostate cancer ( CRPC ) .
EVIDENCE SYNTHESIS Relapse after local therapy is defined by a rising prostate-specific antigen ( PSA ) level > 0.2ng/ml following radical prostatectomy ( RP ) and > 2ng/ml above the nadir after radiation therapy ( RT ) .
And rogen deprivation therapy ( ADT ) remains the basis for treatment of men with metastatic prostate cancer ( PCa ) .
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/m2 every 3 wk and sipuleucel-T. Cabazitaxel , AA/P , enzalutamide , and radium are approved for second-line treatment of CRPC following docetaxel .
CONCLUSIONS The knowledge in the field of advanced and metastatic PCa and CRPC is changing rapidly .
Salvage radiotherapy with or without short-term hormone therapy for rising prostate-specific antigen concentration after radical prostatectomy (GETUG-AFU 16): a randomised, multicentre, open-label phase 3 trial.
BACKGROUND How best to treat rising prostate-specific antigen ( PSA ) concentration after radical prostatectomy is an urgent clinical question . Salvage radiotherapy delays the need for more aggressive treatment such as long-term and rogen suppression , but fewer than half of patients benefit from it . We aim ed to establish the effect of adding short-term and rogen suppression at the time of salvage radiotherapy on biochemical outcome and overall survival in men with rising PSA following radical prostatectomy . METHODS This open-label , multicentre , phase 3 , r and omised controlled trial , was done in 43 French study centres . We enrolled men ( aged ≥18 years ) who had received previous treatment for a histologically confirmed adenocarcinoma of the prostate ( but no previous and rogen deprivation therapy or pelvic radiotherapy ) , and who had stage pT2 , pT3 , or pT4a ( bladder neck involvement only ) in patients who had rising PSA of 0·2 to less than 2·0 μg/L following radical prostatectomy , without evidence of clinical disease . Patients were r and omly assigned ( 1:1 ) central ly via an interactive web response system to st and ard salvage radiotherapy ( three-dimensional [ 3D ] conformal radiotherapy or intensity modulated radiotherapy , of 66 Gy in 33 fractions 5 days a week for 7 weeks ) or radiotherapy plus short-term and rogen suppression using 10·8 mg goserelin by subcutaneous injection on the first day of irradiation and 3 months later . R and omisation was stratified using a permuted block method according to investigational site , radiotherapy modality , and prognosis . The primary endpoint was progression-free survival , analysed in the intention-to-treat population . This trial is registered with Clinical Trials.gov , number NCT00423475 . FINDINGS Between Oct 19 , 2006 , and March 30 , 2010 , 743 patients were r and omly assigned , 374 to radiotherapy  alone and 369 to radiotherapy plus goserelin . Patients assigned to radiotherapy plus goserelin were significantly more likely than patients in the radiotherapy alone group to be free of biochemical progression or clinical progression at 5 years ( 80 % [ 95 % CI 75 - 84 ] vs 62 % [ 57 - 67 ] ; hazard ratio [ HR ] 0·50 , 95 % CI 0·38 - 0·66 ; p<0·0001 ) . No additional late adverse events occurred in patients receiving short-term and rogen suppression compared with those who received radiotherapy alone . The most frequently occuring acute adverse events related to goserelin were hot flushes , sweating , or both ( 30 [ 8 % ] of 366 patients had a grade 2 or worse event ; 30 patients [ 8 % ] had hot flushes and five patients [ 1 % ] had sweating in the radiotherapy plus goserelin group vs none of 372 patients in the radiotherapy alone group ) . Three ( 8 % ) of 366 patients had grade 3 or worse hot flushes and one patient had grade 3 or worse sweating in the radiotherapy plus goserelin group versus none of 372 patients in the radiotherapy alone group . The most common late adverse events of grade 3 or worse were genitourinary events ( 29 [ 8 % ] in the radiotherapy alone group vs 26 [ 7 % ] in the radiotherapy plus goserelin group ) and sexual disorders ( 20 [ 5 % ] vs 30 [ 8 % ] ) . No treatment-related deaths occurred . INTERPRETATION Adding short-term and rogen suppression to salvage radiotherapy benefits men who have had radical prostatectomy and whose PSA rises after a postsurgical period when it is undetectable . Radiotherapy combined with short-term and rogen suppression could be considered as a reasonable option in this population . FUNDING French Ministry of Health , AstraZeneca , and La Ligue Contre le Cancer
Zoledronic acid and denosumab can be used in men with mCRPC and osseous metastases to prevent skeletal-related complications .
PATIENT SUMMARY In men with a rise in their PSA levels after prior local treatment for prostate cancer only , it is important to balance overtreatment against further progression of the disease since survival and quality of life may never be affected in many of these patients .
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 , metastatic , and castration-resistant prostate cancer ( CRPC ) .
EVIDENCE SYNTHESIS Relapse after local therapy is defined by a rising prostate-specific antigen ( PSA ) level > 0.2ng/ml following radical prostatectomy ( RP ) and > 2ng/ml above the nadir after radiation therapy ( RT ) .
And rogen deprivation therapy ( ADT ) remains the basis for treatment of men with metastatic prostate cancer ( PCa ) .
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/m2 every 3 wk and sipuleucel-T. Cabazitaxel , AA/P , enzalutamide , and radium are approved for second-line treatment of CRPC following docetaxel .
CONCLUSIONS The knowledge in the field of advanced and metastatic PCa and CRPC is changing rapidly .