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Austrian recommendations on Targeted Hormone Therapy for metastatic, castration-resistant prostate cancer

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Summary

In recent years, new therapeutic options have brought improvements in the treatment of metastatic, castration-resistant prostate cancer. Targeted Hormone Therapy (THT) represents a novel therapeutic component for which recent studies have shown a maximum benefit in the time between failure of androgen deprivation therapy (patient is metastatic and still pain-free) and prior to chemotherapy. Prostate cancer experts of the Austrian Society of Urology and Andrology (ÖGU), the Working Group for Urologic Oncology as part of the ÖGU, and the Professional Association of Austrian Urologists (BvU) have developed recommendations for the treatment of patients with asymptomatic or mildly symptomatic metastatic, castration-resistant prostate cancer. The definition of failure of classical hormonal therapy has been based on the guidelines of the German Society of Urology (Deutsche Gesellschaft für Urologie, DGU) and the European Association of Urology (EAU). Criteria for the initiation of treatment with hormonal or chemotherapy include:

  • Castration resistance with increase of prostate-specific antigen (PSA)

  • Evidence of metastases in imaging

  • No or mild symptoms

  • Quality of Life Index of the Eastern Cooperative Oncology Group (ECOG) 0-1 (ECOG 2 requires individualized decision) [1].

Treatment should only be initiated when all of these four criteria are applicable, with the age of the patient being no exclusion criterion. First-line therapies for these patients include abiraterone, enzalutamide, and docetaxel as well as radium-223. The manuscript refers only to treatment regimens available in Austria.

Selection of the initial treatment option—starting with THT or chemotherapy—should be determined based on the individual patient characteristics. When using abiraterone or enzalutamide, re-staging within 3–6 months is recommended.

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Abbreviations

ADT:

Androgen deprivation therapy

ALT:

Alanine transaminase

AP:

Alkaline phosphatase

AR-V7:

Androgen receptor splice variant-7

AST:

Aspartate transaminase

AUA:

American Urological Association

AUO:

Working Group of Urologic Oncology (Arbeitskreis für Urologische Onkologie)

BvU:

Professional Association of Austrian Urologists (Berufsverband der Österreichischen Urologen)

CRP:

C-reactive protein

CRPC:

Castration-resistant prostate cancer

CT:

Chemotherapy

DGU:

German Society of Urology (Deutsche Gesellschaft für Urologie)

EAU:

European Association of Urology

ECOG:

Quality of Life Index of the Eastern Cooperative Oncology Group

ESMO:

European Society for Medical Oncology

Hb drop:

Hemoglobin drop

LDH:

Lactate dehydrogenase

mCRPC:

Metastatic, castration-resistant prostate cancer

MRI:

Magnetic resonance imaging

ÖGU:

Austrian Society of Urology and Andrology (Österreichische Gesellschaft für Urologie und Andrologie)

OS:

Overall survival

PCa:

Prostate cancer

PET:

Positron emission tomography

PFS:

Progression-free survival

PSA:

Prostate-specific antigen

RECIST:

Response Evaluation Criteria in Solid Tumors

rPFS:

Radiographic progression-free survival

THT:

Targeted Hormone Therapy

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Authors and Affiliations

  1. Department of Urology and Andrology, Working Group Urologic Oncology (AUO), Hospital Barmherzige Brüder Vienna, Vienna, Austria

    Anton Ponholzer

  2. Department of Urology, Austrian Society of Urology and Andrology (ÖGU), Hospital Barmherzige Schwestern Linz, Linz, Austria

    Wolfgang Loidl

  3. European Prostate Center, University Hospital of Urology, Innsbruck, Austria

    Jasmin Bektic

  4. Urology and Andrology in Vienna, Professional Association of Austrian Urologists (BvU), Vienna, Austria

    Karl Dorfinger

  5. Urology and Andrology, University Hospital, Salzburg, Austria

    Stephan Hruby

  6. Department of Urology and Andrology, Clinic Center Klagenfurt am Wörthersee, Klagenfurt am Wörthersee, Austria

    Klaus Jeschke

  7. Urologic Outpatient Tumor Unit, University Hospital of Urology, Vienna, Austria

    Gero Kramer

  8. Department of Urology, General Hospital of the City of Linz, Linz, Austria

    Steffen Krause

  9. Urology & Andrology, Vienna, Austria

    Georg Ludvik

  10. Department of Urology, Provincial Hospital Korneuburg, Korneuburg, Austria

    Mesut Remzi

  11. KABEG, Clinic Center Klagenfurt am Wörthersee, Klagenfurt am Wörthersee, Austria

    Michael Roider

  12. Department of Urology, Provincial Hospital Vöcklabruck, Vöcklabruck, Austria

    Franz Stoiber

Authors
  1. Anton Ponholzer
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  2. Wolfgang Loidl
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  3. Jasmin Bektic
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  4. Karl Dorfinger
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  5. Stephan Hruby
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  8. Steffen Krause
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  9. Georg Ludvik
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  10. Mesut Remzi
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  12. Franz Stoiber
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Corresponding author

Correspondence to Anton Ponholzer.

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Conflict of interests

The technical organization and conduct of the consensus meeting and the subsequent coordination process as well as the publication of the consensus statements have been facilitated by the company Janssen, though without any influence on the content. The authors declare that there has been no conflict of interests with regard to the publication of this article.

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Ponholzer, A., Loidl, W., Bektic, J. et al. Austrian recommendations on Targeted Hormone Therapy for metastatic, castration-resistant prostate cancer. Wien Klin Wochenschr 128, 156–163 (2016). https://doi.org/10.1007/s00508-015-0945-x

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