Updated AUA/SUO Guideline on Advanced Prostate Cancer Offers New Recommendations on Imaging, Testing

The American Urological Association (AUA) and the Society of Urologic Oncology (SUO) have updated their clinical practice guideline for the treatment of advanced prostate cancer.

The guideline was first published in 2020 and includes recommendations for the treatment and management of biochemical recurrence, metastatic hormone-sensitive prostate cancer (mHSPC), nonmetastatic castration-resistant prostate cancer (nmCRPC), and metastatic castration-resistant prostate cancer (mCRPC).

The updated guideline emphasizes the use of prostate-specific membrane antigen (PSMA) positron emission tomography (PET) imaging for periodic staging, as well as the inclusion of androgen deprivation therapy (ADT) as a monotherapy or in combination with other treatments.

Recommendations found in the updated guideline include:

•  Clinicians should obtain tissue diagnosis of the primary tumor or metastasis site when feasible for   the early evaluation and counseling of patients with suspected advanced prostate cancer.

•  Clinicians should encourage patient engagement with resources such as patient advocacy groups.

•  ADT is strongly recommended as a treatment for patients with mHSPC in combination with androgen pathway-directed therapy (abiraterone acetate plus prednisone, apalutamide, enzalutamide) or chemotherapy (docetaxel).

•  For patients with nmCRPC, serial prostate-specific antigen (PSA) levels should be measured at 3- to 6-month intervals, and PSA doubling time should be calculated at the start of development of castration resistance.

•  Patients with nmCRPC who are at high risk for developing metastatic disease should be offered apalutamide, darolutamide, or enzalutamide with continued ADT.

•  Annual imaging is recommended for patients with mCRPC without PSA progression or new symptoms.

•  In patients who may undergo ADT, clinicians should discuss bone health, including the risk of osteoporosis associated with ADT. The risk of fragility fracture in patients with advanced prostate cancer should be assessed.

•  After the exhaustion of local treatment options, patients with PSA recurrence should be given periodic staging evaluations consisting of cross-sectional imaging and bone scans or PSMA PET imaging.

To view the full list of updated guideline statements, visit auanet.org.