The Swedish national guidelines on prostate cancer, part 2: recurrent, metastatic and castration resistant disease.

Abstract

OBJECTIVE:

There is now an unprecedented amount of evidence to consider when revising prostate cancer guidelines. We believe that there is a value in publishing summaries of national clinical guidelines in English for others to read and comment on.

METHODS:

This is part 2 of a summary of the Swedish prostate cancer guidelines that were published in June 2022. This part covers recurrence after local treatment and management of metastatic and castration resistant disease. Part 1 covers early detection, diagnostics, staging, patient support and management of non-metastatic disease.

RESULTS:

The 2022 Swedish guidelines include several new recommendations. Among these is a recommendation of a period of observation with repeated PSA tests for patients with approximately 10 years' life expectancy who experience a BCR more than 2-5 years after radical prostatectomy, to allow for estimating the PSA doubling time before deciding whether to give salvage radiotherapy or not. Recent results from the PEACE-1 trial led to the recommendation of triple-treatment with a GnRH agonist, abiraterone plus prednisolone and 6 cycles of docetaxel for patients with high-volume metastatic disease who are fit for chemotherapy. The Swedish guidelines differ from the European ones by having more restrictive recommendations about genetic testing of and high-dose zoledronic acid or denosumab treatment for men with metastatic prostate cancer, and by recommending considering bicalutamide monotherapy for selected patients with low-volume metastatic disease.

CONCLUSIONS:

The 2022 Swedish prostate cancer guidelines include several new recommendations and some that differ from the European guidelines.

• Authors: Ola Bratt, Stefan Carlsson, Per Fransson, Jon Kindblom, Johan Stranne, Camilla Thellenberg Karlsson, Swedish National Prostate Cancer Guidelines Group
• Journal: Scandinavian journal of urology (Scand J Urol) Vol. 56 Issue 4 Pg. 278-284 (Aug 2022) ISSN: 2168-1813 [Electronic] Sweden
• PMID: 35798533 (Publication Type: Journal Article)

Chemical References

• Docetaxel
• Gonadotropin-Releasing Hormone
• Denosumab
• Zoledronic Acid
• Prednisolone
• Prostate-Specific Antigen

Topics

• Antineoplastic Combined Chemotherapy Protocols (therapeutic use)
• Denosumab (therapeutic use)
• Docetaxel (therapeutic use)
• Gonadotropin-Releasing Hormone (therapeutic use)
• Humans
• Male
• Orchiectomy
• Prednisolone (therapeutic use)
• Prostate-Specific Antigen
• Prostatic Neoplasms, Castration-Resistant (drug therapy)
• Sweden
• Zoledronic Acid (therapeutic use)