What are the ASCO/CCO guidelines on the treatment of castration-resistant prostate cancer (CRPC)?

Updated: Jul 31, 2017
  • Author: Bagi RP Jana, MD; more...
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Answer

Answer

ASCO and CCO released a joint clinical practice guideline for treatment of men with mCRPC in 2014. [8] The guideline recommendations include the following:

  • Pharmacologic androgen deprivation therapy (ADT) should be continued indefinitely

  • Offer patients one of three treatment options—abiraterone/prednisone, enzalutamide, or radium-223 (if cancer has spread to bone)—in addition to hormone deprivation

  • When considering chemotherapy, docetaxel/prednisone should be an option but side effects must be discussed

  • Offer cabazitaxel to men whose disease worsens even if docetaxel has been tried, but again, discuss side effects

  • Offer sipuleucel-T to men with no symptoms or minimal symptoms of cancer

  • Offer mitoxantrone, but include a discussion of the drug's limited clinical benefit and side effect risk

  • Offer ketoconazole or the anti-androgen therapies bicalutamide, flutamide or nilutamide but discuss the limited clinical benefit for these three medications

  • Do not offer the drugs bevacizumab (Avastin), estramustine, or sunitinib

  • Begin discussion of palliative care early on while discussing treatment options


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