Attitudes to prostate cancer have changed dramatically over the last 30 years, prior to that time prostate cancer was often considered to require little treatment as it was considered to occur primarily in elderly men and was more often than not metastatic at the time of diagnosis and the only treatment plan often was orchidectomy.
A number of factors have brought about this very significant change in attitude to the management of prostate cancer. The discovery of prostate specific antigen (PSA) coupled with ultra sound guided biopsy of the prostate has meant that prostate cancer is now diagnosed at least a decade or more earlier than was the case in the 1970’s and is more likely to be confined to the prostate. The development of nerve sparing techniques and the increased familiarity with radical prostatectomy also the introduction of high dose and more focussed external beam radiation as well as the introduction of brachytherapy have all made local treatment more effective and with reduced morbidity.
However, in spite of these advances a significant proportion of men will still be identified with or develop metastatic disease. This is usually determined now on the basis of a rising PSA after attempts at cure by one of the previously described modalities. However, even in this situation Pound et al 1999 data indicated that the median actuarial time for death was 13 years after the initial PSA rise. We cannot cure metastatic disease but given the long life expectancy after the initial PSA rise it is important that men in this situation received the most appropriate treatment to ensure both prolongation of and high quality of life. These guidelines attempt to bring together the best evidence currently available to achieve this goal.
I would like to recognise the work of Professor Dianne O’Connell who has managed the process on behalf of the steering committee and her dedicated small group of researchers who have reviewed the tens of thousands of articles necessary to support this process. Dr Carol Pinnock for developing the consumer guide and Emeritus Professor Tom Reeve AC CBE, whose experience in guideline development and direction has been vital to the success of the project.
I would also like to acknowledge the contribution of the members of the steering committee who have freely given of their time and expertise to bring this project to fruition.
The scope of the exercise turned out to be far greater than we envisaged when we embarked on the project and if it had not been for the generous financial support of Andrology Australia, The Prostate Cancer Foundation of Australia, Cancer Council New South Wales and the Australian Cancer Network we would not have been able to undertake what we believe is the most comprehensive review of the evidence for the management of advanced and metastatic prostate cancer that has been undertaken to date. (See Appendix – Guideline development process).
Chair, Management of Metastatic Prostate Cancer Guidelines Working Party
- Pound CR, Partin AW, Eisenberger MA, Chan DW, Pearson JD, Walsh PC. Natural history of progression after PSA elevation following radical prostatectomy. JAMA 1999 May 5;281(17):1591-7 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/10235151.