Guidelines:Prostate cancer/Management/Locally advanced and metastatic/Overt metastatic disease and or loco-regional progressive disease
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Clinical practice guidelines for the management of locally advanced and metastatic prostate cancer > Guidelines:Prostate cancer/Management/Locally advanced and metastatic/Overt metastatic disease and or loco-regional progressive disease
Androgen deprivation therapy
- Is any one hormone therapy (androgen ablation) superior to another when given in the first line setting in terms of survival in metastatic disease?
- Is there any survival advantage for maximum androgen blockade (or combined hormone therapy) compared with single agent androgen blockade when used as first line therapy in metastatic disease?
- For patients with radiologically detectable but asymptomatic disease should hormone therapy be started immediately or should it be started at the onset of symptoms?
- Are there differences between the different hormone therapy methods in the pattern and severity of toxicity effects, specifically symptoms such as hot flushes, gynecomastia, liver function and gastrointestinal, effect on sexual function and cognitive function and possible long term side effects such as changes in body composition and metabolic syndrome in metastatic disease?
- What is the effect on Quality of Life as measured by validated questionnaires due to androgen ablation (deprivation or blockade) treatment in metastatic disease?
- Is there a difference in survival for intermittent androgen deprivation compared to continuous androgen deprivation?
- What is the effectiveness of local external beam radiotherapy (EBRT) in the palliation of uncomplicated bone pain?
- What is the evidence for the effect of radiotherapy in palliation of soft tissue disease of EBRT to the prostate for symptom treatment in locally advanced disease and to local metastases such as the lymph nodes for symptom treatment such as lymphoedema and painful lymph nodes?
- What is the benefit of EBRT alone given for malignant spinal cord compression?
- What is the role of surgery in the treatment of malignant spinal cord compression?
- What is the efficacy of steroids for the treatment of malignant spinal cord compression?
- What is the efficacy of Hemibody (widefield) external beam radiotherapy in the palliation of uncomplicated bone pain?
- See Emerging therapies for ongoing trials in this area.
- No recommendations have been made for hormone naïve metastatic disease. See What is the evidence for the use of bisphosphonates in the prevention of skeletal events? for a discussion of a single trial of bisphononates for hormone-naïve metastatic bone disease.