Current prostate cancer (PC) guidelines primarily focus on localized or metastatic PC. A multidisciplinary genitourinary oncology panel determined that additional guidance focusing on monitoring and management of biochemical recurrence (BCR) following radical therapy and non-metastatic castration-resistant prostate cancer (nmCRPC) was warranted.

The most up-to-date national and international guidelines, consensus statements, and emerging phase 3 trials were identified and used to inform development of algorithms by a multidisciplinary genitourinary oncology panel outlining optimal monitoring and treatment for patients with non-metastatic PC.

A total of eight major national and international guidelines/consensus statements published since 2015 and three phase 3 trials were identified. Working group discussions among the multidisciplinary genitourinary oncology panel led to the development of two algorithms: the first addressing management of patients with BCR following radical therapy (post-BCR), and the second addressing management of nmCRPC. The post-BCR algorithm suggests consideration of early salvage treatment in select patients, and provides guidance regarding observation vs. intermittent or continuous androgen-deprivation therapy (ADT). The nmCRPC algorithm suggests continued ADT and monitoring for all patients, with consideration of treatment with apalutamide or enzalutamide for patients with high-risk disease (prostate-specific antigen [PSA] doubling time of ≤10 months).

Two treatment algorithms have been developed to guide the management of non-metastatic PC, and should be considered in the context of local guidelines and practice patterns.

Canadian Urological Association journal = Journal de l’Association des urologues du Canada. 2019 Feb 07 [Epub ahead of print]

Brita Danielson, Fred Saad, Alan So, Scott Morgan, Robert J Hamilton, Shawn Malone, Laura Park-Wyllie, Anousheh Zardan, Bobby Shayegan

Cross Cancer Institute, University of Alberta, Edmonton, AB, Canada., Centre Hospitalier de l’Université de Montréal, University of Montreal, Montreal, QC, Canada., Vancouver Prostate Centre, University of British Columbia, BC, Canada., The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada., Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada., Medical Affairs, Janssen Inc., Toronto, ON, Canada., Juravinski Cancer Centre, McMaster University, Hamilton, ON, Canada.