Prostate news article, May 2006
AMERICAN
UROLOGICAL ASSOCIATION 2006 UPDATE: Professor Roger S Kirby Visiting Professor to St George's Hospital, London |
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AUA Guidelines for the diagnosis and treatment of prostate cancer (CaP) were presented by Dr. Michael Cookson, Vanderbilt University at the plenary session of the AUA meeting in Atlanta, Georgia on Tuesday, May 23 2006.
Dr.Cookson thanked Drs. Ian Thompson and Brant Thrasher for their help with the development of the guidelines. The guidelines panel included radiation oncologists, urologists, statisticians and outcomes researchers. It was an international panel. Dr. Cookson said that almost 50,000 papers have been published on localized CaP, over 12,000 were reviewed and 500 met the criteria for evaluation.
Risk stratification should be defined for low-, intermediate- and high-risk patients and the guidelines provide criteria for this. Once risk assessment is made, guidelines were developed for patients within each risk category. Dr.Cookson said that any treatment is an option due to the lack of randomized trials. Surgery, brachytherapy and radiotherapy are all acceptable options for low-risk disease. The urologist should inform the patients about the evidence surrounding treatment outcomes. Patients should know that RP was associated with improved survival over observation. For low-risk CaP, Dr.Cookson pointed out that 2 randomized trials showed higher doses had better outcomes. In low and intermediate-risk the patients' functional status is important to consider. All treatment options also apply to intermediate-risk patients. He pointed out that neoadjuvant AD improved outcomes with radiotherapy and should be given.
For high-risk patients, Dr.Cookson stated that primary therapies alone resulted in significant risk of recurrence. Also, the addition of AD to XRT results in improved outcomes. First line AD is not recommended for non-metastatic CaP. Overall, the guidelines reflect a lack of Level I evidence based data upon which to make concrete recommendations
Report by Professor Roger Kirby
2006-05-24