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Wiener klinische Wochenschrift

, Volume 128, Issue 3–4, pp 156–163 | Cite as

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

  • Anton Ponholzer
  • Wolfgang Loidl
  • Jasmin Bektic
  • Karl Dorfinger
  • Stephan Hruby
  • Klaus Jeschke
  • Gero Kramer
  • Steffen Krause
  • Georg Ludvik
  • Mesut Remzi
  • Michael Roider
  • Franz Stoiber
consensus report
  • 297 Downloads

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.

Keywords

Metastatic, castration-resistant prostate cancer Treatment sequence Targeted Hormone Therapy Abiraterone Enzalutamide 

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

Notes

Compliance with ethical standards

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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Copyright information

© Springer-Verlag Wien 2016

Authors and Affiliations

  • Anton Ponholzer
    • 1
  • Wolfgang Loidl
    • 2
  • Jasmin Bektic
    • 3
  • Karl Dorfinger
    • 4
  • Stephan Hruby
    • 5
  • Klaus Jeschke
    • 6
  • Gero Kramer
    • 7
  • Steffen Krause
    • 8
  • Georg Ludvik
    • 9
  • Mesut Remzi
    • 10
  • Michael Roider
    • 11
  • Franz Stoiber
    • 12
  1. 1.Department of Urology and Andrology, Working Group Urologic Oncology (AUO)Hospital Barmherzige Brüder ViennaViennaAustria
  2. 2.Department of Urology, Austrian Society of Urology and Andrology (ÖGU)Hospital Barmherzige Schwestern LinzLinzAustria
  3. 3.European Prostate CenterUniversity Hospital of UrologyInnsbruckAustria
  4. 4.Urology and Andrology in ViennaProfessional Association of Austrian Urologists (BvU)ViennaAustria
  5. 5.Urology and AndrologyUniversity HospitalSalzburgAustria
  6. 6.Department of Urology and AndrologyClinic Center Klagenfurt am WörtherseeKlagenfurt am WörtherseeAustria
  7. 7.Urologic Outpatient Tumor UnitUniversity Hospital of UrologyViennaAustria
  8. 8.Department of UrologyGeneral Hospital of the City of LinzLinzAustria
  9. 9.Urology & AndrologyViennaAustria
  10. 10.Department of UrologyProvincial Hospital KorneuburgKorneuburgAustria
  11. 11.KABEGClinic Center Klagenfurt am WörtherseeKlagenfurt am WörtherseeAustria
  12. 12.Department of UrologyProvincial Hospital VöcklabruckVöcklabruckAustria

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