Castration Resistant Cancer
MCRPC
(Adenocarcinoma)
MCRPC is castration-resistant prostate cancer with distant metastases
Treatment Pathways
Treatment Options: Group 1
I. Patient has no prior docetaxel (chemotherapy) treatment, AND no prior treatment with novel hormone therapy (abiraterone, darolutamide, apalutamide, enzalutamide)
ADT with:
- Preferred treatment regimens:
- Abiraterone
- Docetaxel
- Enzalutamide
- Useful in certain circumstances:
- Sipuleucel-T
- Radium 223 for symptomatic bone metastases
- Olaparib / abiraterone for BRCA mutation
- Niraparib / abiraterone for BRCA mutation
- Talazoparib / enzalutamide for HRRm
- Other recommended treatment regimens:
- Other secondary hormone therapy
Option Overview
Treatment Options: Group 2
II. Patient has prior docetaxel (chemotherapy) treatment, BUT no prior treatment with novel hormone therapy (abiraterone, darolutamide, apalutamide, enzalutamide)
ADT with:
- Preferred treatment regimens:
- Abiraterone
- Cabazitaxel (chemotherapy)
- Enzalutamide
- Useful in certain circumstances:
- Mitoxantrone
- Cabazitaxel/carboplatin (chemotherapy)
- Sipuleucel-T
- Radium 223
- Talazoparib / enzalutamide for HRRm
- Olaparib / abiraterone for BRCA mutation
- Niraparib / abiraterone for BRCA mutation
- Other recommended treatment regimens:
- Other secondary hormone therapies
- First-generation antiandrogen (bicalutamide, flutamide, nilutamide)
- Corticosteroids (hydrocortisone, prednisone, dexamethasone)
- Ketoconazole plus hydrocortisone
- Antiandrogen withdrawal
- Other secondary hormone therapies
Option Overview
Treatment Options: Group 3
III. Patient has prior treatment with novel hormone therapy (abiraterone, darolutamide, apalutamide, enzalutamide), BUT No prior docetaxel (chemotherapy) treatment
ADT with:
- Preferred treatment regimens:
- Docetaxel
- Useful in certain circumstances:
- Sipuleucel-T
- Olaparib for HRRm
- Talazoparib / enzalutamide for HRRm
- Cabazitaxel / carboplatin (chemotherapy)
- Radium 223
- Rucaparib for BRCA mutation
- Niraparib/abiraterone for BRCA mutation
- Other recommended therapies:
- Abiraterone
- Abiraterone plus dexamethasone
- Enzalutamide
- Other secondary hormone therapies
- First-generation antiandrogen (bicalutamide, flutamide, nilutamide)
- Corticosteroids (hydrocortisone, prednisone, dexamethasone)
- Ketoconazole plus hydrocortisone
- Antiandrogen withdrawal
Option Overview
Treatment Options: Group 4
IV. Patient has prior docetaxel (chemotherapy) treatment, AND prior treatment with novel hormone therapy (abiraterone, darolutamide, apalutamide, enzalutamide)
ADT with:
- Preferred treatment regimens:
- Cabazitaxel (chemotherapy)
- Docetaxel rechallenge
- Useful in certain circumstances:
- Lutetium Lu 177 vipivotide tetraxetan (Lu-177–PSMA-617) for PSMA positive metastases
- Olaparib for HRRm
- Cabazitaxel / carboplatin (chemotherapy)
- Radium 223 for symptomatic bone metastases
- Rucaparib for BRCA mutation
- Mitoxantrone
- Pembrolizumab
- Other recommended regimens:
- Abiraterone
- Enzalutamide
- Other secondary hormone therapies
- First-generation antiandrogen (bicalutamide, flutamide, nilutamide)
- Corticosteroids (hydrocortisone, prednisone, dexamethasone)
- Ketoconazole plus hydrocortisone
- Antiandrogen withdrawal
Option Overview
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.
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.
