2020 version of NCCN and EAU prostate cancer guide important updates, experts to help you sum up!

There are 11 update points in the two heavyweight guides. Have you got them? At the boa / BOC online conference, Professor Xie Xiaodong from the cancer diagnosis and treatment center of the northern theater general hospital gave us a detailed explanation of the update points of the national comprehensive cancer network (NCCN) / European Urology Association (EAU) clinical diagnosis and treatment guidelines for prostate cancer (version 2020 V1).key points of updating NCCN prostate cancer guidelines (version 2020 V1) 1. Gene detection and molecular marker analysis of advanced prostate cancer. Molecular marker analysis of metastasis risk group was changed to: homologous recombination repair mutation (hrrm) detection in embryo line, and microsatellite instability (MSI) or mismatch repair defect (dmmr) detection should be considered.2. New page - genetic principles (germ line gene testing) are used for patients with family and personal history of cancer or known germ line variation at the time of initial diagnosis.reproductive gene testing is recommended for patients with high-risk, extremely high-risk, limited or metastatic prostate cancer; German Jewish origin; family history of high-risk germline mutations (such as BRCA1 / 2, Lynch mutations); and positive family history of tumors.limited data: cribriform (ductal or intraductal) prostate cancer can increase genomic instability.patients with known family history of germline variation should include: MLH1, MSH2, MSH6, PMS2 (for Lynch syndrome) and homologous recombination genes BRCA1 / 2, ATM, PALB2 and CHEK2.for patients with unknown family history or clinical characteristics, the efficiency of gene detection may be low.the analysis of 692 cases without family history showed that 11.8% of them had genetic (reproductive) DNA repair gene mutations, while 6% of them were in the TCGA database cohort.3. Monitoring and recurrence should be changed to: physical examination + prostate specific antigen (PSA) test every 3-6 months when androgen deprivation therapy (ADT) or observation is conducted for N1; add: imaging examination for patients with symptoms or elevated PSA; delete: bone imaging examination for symptomatic patients every 6-12 months; modify the footnotes to: if the disease progression (PD) after ADT, the castrated testis should be recorded If there is no evidence of metastasis, consider 11-c choline PET / CT or PET / MRI or F-18 flexible PET / CT or PET / MRI for further detection of soft tissue and bone, or 18 f-naf PET / CT or PET / MRI for further detection of bone.4. ADT combined with the following preferred regimens was used for patients with M1 stage prostate cancer without castration: abalumide (type 1), abitelon (group 1), docetaxel (75 mg / m2 / 6 cycles, category 1), nzalumide (group 1); small particle abitelone (Group 2b); bone imaging of symptomatic patients every 6-12 months was replaced by imaging of symptomatic or elevated PSA Conclusion: MSI-H or dmmr detection and homologous recombination mutation detection are recommended; patients with M0 stage under observation should receive appropriate treatment (for non castrated diseases).the PSA doubling time (psadt) of 5 M0 castrated resistant prostate cancer (CRPC) was more than 10 months, and "observation (preferred)" was added; when psadt was less than 10 months, the preferred regimen was: apalumide (group 1), dolamide (group 1), and nzalumide (group 1); other recommended regimens: other second-line hormone therapy; added footnotes: although serum testosterone level was less than 50NG / dl, CRPC may have clinical progress, imaging progress or biochemical progress.6. Systematic treatment of stage M1 CRPC: biopsy is recommended for metastatic CRPC (mcrpc) with positive traditional imaging examination; for mcrpc with positive traditional imaging examination, it is recommended to test MSI-H / dmmr embryonic homologous recombination gene detection if it has not been done before; delete: other schemes: immunotherapy combined with sipuleucel-t (type 1); delete: "visceral metastasis" and "visceral metastasis" For the first-line and follow-up treatment of small cell prostate cancer / neuroendocrine prostate cancer: add atilizumab / carboplatin / etoposide (Category 3); modify the footnotes: refer to NCCN guidelines for small cell lung cancer for other follow-up options.7. The first-line treatment of m1crpc (adenocarcinoma) system treatment: preferred scheme: abitiron (type 1), docetaxel (type 1), nzalutamide (type 1), sipuleucel-t (type 1); specific regimen: radium-223 (bone metastasis symptoms) (Category 1); mitoxantrone for palliative treatment with visceral metastasis symptoms that can not tolerate other treatments (type 2A); other recommendations: fine particle Other second-line hormone therapy (class 2a) was used.second line treatment (first-line abitelon / nzalumide): preferred regimen: docetaxel (type 1), sipuleucel-t (type 1); specific regimen: olapali (hrrm) (class 2b), pabolizumab (MSI-H or dmmr) (class 2b), radium-223 (bone metastasis symptoms) (type 1); other recommendations: abitelon (class 2a), carbataxel (class 2a), enzalumide (2) Methods: a), fine particle abietarone (class 2a), other second-line hormone therapy (class 2a); delete: best supportive treatment.second line treatment (first-line docetaxel): preferred scheme: abitiron (type 1), carbataxel (type 1), nzalutamide (type 1) specific regimen: mitoxantrone for palliative treatment with visceral metastasis symptoms that can not tolerate other treatments (type 2A), olapali (hrrm) (class 2b), pabolizumab (MSI-H or dmmr) (class 2b), radium-223 (bone metastasis) Other recommendations: consider docetaxel retreatment (category 2a), fine particle abietarone (class 2a), sipuleucel-t (category 2a), and other second-line hormone therapy (category 2a); delete: best supportive treatment.follow up treatment: the preferred regimen is abitelone (Class 1), carbataxel (Class 1), docetaxel (Class 1), and nzalutamide (Class 1); specific regimen: pabolizumab (MSI-H or dmmr) (class 2b), mitoxantrone for palliative treatment with internal metastasis symptoms (class 2a), radium-223 (bone metastasis symptoms) (type 1); other therapies Recommendation: fine particle abietarone (class 2b), other second-line hormone therapy (class 2b).Update points of the 2020 Eau prostate cancer guidelines 1. Screening and early monitoring provide early PSA testing for men with increased risk of prostate cancer: men over 40 years old with BRCA2 mutation (category 2B, highly recommended).2. First line treatment of metastatic prostate cancer provides ADT treatment for M1 symptomatic patients to alleviate symptoms and reduce the risk of severe sequelae caused by advanced diseases (spinal cord compression, pathological fracture, ureteral obstruction) (highly recommended); patients with M1 disease for the first time and suitable for the scheme are given ADT + abitelone + prednisone or apalumide or nzalumide (strongly recommended) Recommended).3. The first-line treatment of CRPC should be based on clinical manifestations, symptoms, comorbidities, location and degree of disease, preference of patients, and treatment of previous hormone sensitive prostate cancer (HSPC) (highly recommended); supportive care of CRPC: monitoring serum calcium Patients with non metastatic CRPC (nm-crpc) and high risk of metastasis (psadt < 10 months) should be treated with abalumide, darolumide or nzalutamide, which is highly recommended.4) quality of life and prognosis it is recommended that men should take ADT, maintain a healthy weight and diet, quit smoking, and conduct annual screening for diabetes and hypercholesterolemia to ensure that calcium and vitamin d meet the recommended levels; and double emission X-ray bone densitometer (DEXA) scanning should be provided for men who have just started long-term ADT to assess bone mineral density.the update of NCCN and Eau prostate cancer guidelines in 2020 is based on evidence-based medical evidence such as latitude, arches, Spartan, Galahad, keynote-365, etc.; the update points mainly focus on the changes of gene detection and treatment methods, and expect the experience and data of prostate cancer diagnosis and treatment in China to go to the world.