Cancer Progression After Radiation

Treatment Options

• Life expectancy more than 5 years; biopsy negative
  • Consider re-biopsy and
    • Monitoring or
    • Androgen Deprivation Therapy (ADT) based on PSA or
    • Local therapy +/- ADT
      • Cryotherapy, or
      • High-intensity focused ultrasound (HIFU), or
      • Brachytherapy
• Life expectancy more than 5 years; pelvic recurrence biopsy positive
  • Consider re-biopsy  and
    • Monitoring or
    • ADT +/- abiraterone or
    • Local therapy
      • +/- ADT, Cryotherapy, or
      • +/- ADT, HIFU, or
      • +/- ADT, Brachytherapy

• • Life expectancy more than 5 years
    • High-volume (the presence of visceral metastasis or ≥4 bone lesions with ≥1 beyond the vertebral bodies and pelvis)
    • ADT with docetaxel and one of the following:
    • Preferred regimens:
      • Abiraterone (category 1)
      • Darolutamide (category 1)
    • Other recommended regimens:
      • Apalutamide (category 2B)
      • Enzalutamide (category 2B) or
    • ADT with one of the following:
    • Low-volume

• Observation: History and physical exam every 12 months or as needed

CLINICAL TRIALS:
NCCN recognizes the importance of clinical trials and encourages participation when applicable and available. Trials should be designed to maximize inclusiveness and broad representative enrollment.

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.