Purpose:  In 2006, the ASCO Board of Directors (BOD) approved a policy and a set of procedures for endorsing clinical practice guidelines that have been developed by other professional organizations.

Methods:  The Cancer Care Ontario (CCO) Guideline on Non-Hormonal Therapy for Men With Metastatic Hormone-Refractory Prostate Cancer (HRPC) was reviewed for developmental rigor by methodologists.  An ad hoc prostate cancer guideline review panel consisting of prostate cancer experts reviewed the content.

Results: The ASCO ad hoc prostate cancer guideline review panel concurred that the recommendations are clear, thorough, based upon the most relevant scientific evidence in this content area, and present options that will be acceptable to patients.  The CCO guideline was subsequently endorsed by the ASCO BOD.  The guideline recommends the use of docetaxel, prednisone/hydrocortisone, and/or mitoxantrone in specific settings.  Docetaxel-based chemotherapy is the only treatment that has demonstrated an overall survival benefit in men with HRPC.  Use of estramustine in combination with other cytotoxic agents is not recommended.  Continued gonadal androgen suppression and discontinuance of anti-androgens is recommended for men receiving chemotherapy.

Conclusion: The review panel agreed with the recommendations as stated in the CCO guideline, with the following qualifications:  two of the ASCO content reviewers noted the importance of considering other, nonhormonal therapies in this context which are beyond the scope of this guideline.  The review panel notes that the CCO has published separate guidelines on radiopharmaceuticals and bisphosphonates in men with castration-resistant (ie, hormone-refractory) metastatic prostate cancer.



ASCO’s practice guidelines and technology assessments reflect expert consensus based on clinical evidence and literature available at the time they are written, and are intended to assist physicians in clinical decision-making and identify questions and settings for further research.  Due to the rapid flow of scientific information in oncology, new evidence may have emerged since the time a guideline or assessment was submitted for publication.  Guidelines and assessments are not continually updated and may not reflect the most recent evidence.  Guidelines and assessments cannot account for individual variation among patients, and cannot be considered inclusive of all proper methods of care or exclusive of other treatments.  It is the responsibility of the treating physician or other health care provider, relying on independent experience and knowledge of the patient, to determine the best course of treatment for the patient.  Accordingly, adherence to any guideline or assessment is voluntary, with the ultimate determination regarding its application to be made by the physician in light of each patient's individual circumstances.  ASCO guidelines and assessments describe the use of procedures and therapies in clinical practice and cannot be assumed to apply to the use of these interventions in the context of clinical trials. ASCO assumes no responsibility for any injury or damage to persons or property arising out of or related to any use of ASCO’s guidelines or assessments, or to any errors or omissions.