Guía de la EAU sobre el cáncer de próstata: Parte II: tratamiento del cáncer de próstata avanzado, recidivante y resistente a la castración

objectives: our aim is to present a summary of the 2010 version of the european association of urology (eau) guidelines on the treatment of advanced, relapsing, and castration-resistant prostate cancer (crpc). methods: the working panel performed a literature review of the new data emerging from 2007 to 2010. the guidelines were updated, and the levels of evidence (les) and/or grades of recommendation (gr) were added to the text based on a systematic review of the literature, which included a search of online databases and bibliographic reviews. results: luteinising hormone-releasing hormone (lhrh) agonists are the standard of care in metastatic prostate cancer (pca). although lhrh antagonists decrease testosterone without any testosterone surge, their clinical benefit remains to be determined. complete androgen blockade has a small survival benefit of about 5%. intermittent androgen deprivation (iad) results in equivalent oncologic efficacy when compared with continuous androgen-deprivation therapy (adt) in well-selected populations. in locally advanced and metastatic pca, early adt does not result in a significant survival advantage when compared with delayed adt. relapse after local therapy is defined by prostate-specific antigen (psa) values > 0.2 ng/ml following radical prostatectomy (rp) and > 2 ng/ml above the nadir after radiation therapy (rt). therapy for psa relapse after rp includes salvage rt at psa levels < 0.5 ng/ml and salvage rp or cryosurgical ablation of the prostate in radiation failures. endorectal magnetic resonance imaging and 11c-choline positron emission tomography/computed tomography (ct) are of limited importance if the psa is < 2.5 ng/ml; bone scans and ct can be omitted unless psa is >20 ng/ml. follow-up after adt should include screening for the metabolic syndrome and an analysis of psa and testosterone levels. treatment of castration-resistant prostate cancer (crpc) includes second-line hormonal therapy, novel agents, and chemotherapy w