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Bulletin du Cancer

Standards, Options and Recommendations for the management of prostate cancer: therapeutic decision criteria Volume 89, issue 6, Juin 2002

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Context: The "Standards, Options and Recommendations" (SOR) collaborative project was initiated in 1993 by the Federation of the French Cancer Centres (FNCLCC), with the 20 French Regional Cancer Centres, several French public university and general hospitals, as well as private clinics and medical speciality societies. Its main objective is the development of serviceable clinical practice guidelines in order to improve the quality of health care and the outcome of cancer patients. The methodology is based on a literature review, followed by critical appraisal by a multidisciplinary group of experts. Draft guidelines are produced, then validated by specialists in cancer care delivery. Objectives: Produce clinical practice guidelines for prostate cancer patients related to therapeutic main decision criteria, using the methodology developed by the Standards, Options and Recommendations project. Methods: The FNCLCC and the French Urology Society (AFU) set-up a multidisciplinary group of experts which reviewed the available evidence. Following the selection of pertinent articles, synthesis of the results, and production of the draft SOR, the document was validated by independent reviewers. Results: The main recommendations are: 1) Specific survival with a minimum of 15 years follow-up, is required to assess the impact of a treatment for localised prostate cancer. 2) Ten-year metastatic-free survival is a good endpoint for assessing treatment efficacy for local cancer. 3) Complete remission is defined as undetectable PSA concentration (< 0.1 mug.L- 1). 4) Progression after radical prostactectomy, external-beam radiotherapy or brachytherapy is defined as an increase PSA concentration, measured in three successive determinations, at monthly intervals. 5) Clinical stage, Gleason score and pretherapeutic PSA concentration are the prognostic factors for locoregional involvement and therefore treatment response, which should be used as an aid for therapeutic decision-making.