Advanced Hormone Sensitive Cancer

(Castration-naive)

For patients with advanced prostate cancer that still responds to hormone (androgen deprivation) treatment.

 

Treatment Options

Without Metastases

  • Monitoring (preferred)
    • Physical exam with PSA every 3 – 6 months
    • Imaging for symptoms or increasing PSA
  • Androgen Deprivation Therapy (ADT)
  • Useful in certain circumstances:
    • Enzalutamide ± leuprolide
    • Apalutamide + ADT (category 2B)

With Metastases

  • ADT with docetaxel and one of the following:
    • Preferred regimens:
      • Abiraterone
      • Darolutamide
    • Other recommended regimens:
      • Apalutamide
      • Enzalutamide or
  • ADT with one of the following:
    • Preferred regimens:
      • Abiraterone
      • Apalutamide
      • Enzalutamide
    • Other Recommended regimens:
      • Darolutami

  • Low-volume (synchronous) ADT with one of the following:

    • Preferred regimens:

      • Abiraterone

      • Apalutamide

      • Enzalutamide

    • Other recommended regimens:

      • Darolutamide

  • ADT with EBRT to the primary tumor alone or with one of the following:

    • Abiraterone

    • Apalutamide

    • Docetaxel

    • Enzalutamide

  • ADT with docetaxel and one of the following:

    • Abiraterone

    • Darolutamide

    • Apalutamide

    • Enzalutamide

  • Low-volume (Metachronous) ADT with one of the following:

    • Preferred regimens:

      • Abiraterone

      • Apalutamide

      • Enzalutamide

    • Other Recommended Regimens

      • Darolutamide

CLINICAL TRIALS:
NCCN believes that the best management of any patient with cancer is in a clinical trial. Participation in clinical trials is especially encouraged.

Referenced with permission from the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Prostate Cancer Version 4.2023
© National Comprehensive Cancer Network, Inc. 2022. All rights reserved. The complete and current version of the guideline is available at NCCN.org.

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IMPORTANT:

This information is provided for educational purposes only to support patients in understanding and discussing appropriate treatment options with their doctors. Included is information from treatment guidelines for doctors and other sources. However, this information should not be considered as patient treatment guidelines or recommendations, but as educational materials only. Patients should discuss treatments identified herein with their doctors to understand the risks and benefits of each based on their personal diagnosis. Treatment decisions should only be made between the patient and his doctor.

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