The Swedish national guidelines on prostate cancer, part 2: recurrent, metastatic and castration resistant disease

Abstract

Objective

There is now an unprecedented amount of evidence to consider when revising prostate cancer guidelines. We believe that there is a value in publishing summaries of national clinical guidelines in English for others to read and comment on.

Methods

This is part 2 of a summary of the Swedish prostate cancer guidelines that were published in June 2022. This part covers recurrence after local treatment and management of metastatic and castration resistant disease. Part 1 covers early detection, diagnostics, staging, patient support and management of non-metastatic disease.

Results

The 2022 Swedish guidelines include several new recommendations. Among these is a recommendation of a period of observation with repeated PSA tests for patients with approximately 10 years’ life expectancy who experience a BCR more than 2–5 years after radical prostatectomy, to allow for estimating the PSA doubling time before deciding whether to give salvage radiotherapy or not. Recent results from the PEACE-1 trial led to the recommendation of triple-treatment with a GnRH agonist, abiraterone plus prednisolone and 6 cycles of docetaxel for patients with high-volume metastatic disease who are fit for chemotherapy. The Swedish guidelines differ from the European ones by having more restrictive recommendations about genetic testing of and high-dose zoledronic acid or denosumab treatment for men with metastatic prostate cancer, and by recommending considering bicalutamide monotherapy for selected patients with low-volume metastatic disease.

Conclusions

The 2022 Swedish prostate cancer guidelines include several new recommendations and some that differ from the European guidelines.

Keywords:

• Prostate cancer
• guidelines
• recurrence
• treatment
• metastatic
• castration resistant

Acknowledgement

Fredrik Sandin, statistician at Regional Cancer Centre Mid-Sweden in Uppsala, provided data from the National Prostate Cancer Register of Sweden (NPCR).

Disclosure statement

In accordance with Taylor & Francis policy and my ethical obligation as a researcher, I am reporting that none of the authors have any ongoing financial and/or business interests in any company that may be affected by the research reported in the enclosed paper.