Optimizing Anticancer Therapy in Metastatic Non-Castrate Prostate Cancer
Publication Date: April 2, 2018
Last Updated: April 1, 2024
Treatment
ADT + Docetaxel
For men with metastatic non-castrate prostate cancer with high volume disease per CHAARTED who are candidates for treatment with chemotherapy, the addition of docetaxel to ADT should be offered. (EB, H, S)
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For patients with low volume disease per CHAARTED who are candidates for chemotherapy, docetaxel plus ADT may be offered. (EB, H, M)
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The appropriate regimen of docetaxel is six doses of docetaxel given every three weeks at 75 mg/m2 either alone (per CHAARTED) or with prednisolone (per STAMPEDE). (EB, H, S)
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ADT + Abiraterone
For men with high-risk de novo metastatic non-castrate prostate cancer, the addition of abiraterone to ADT should be offered, per LATITUDE. (EB, H, S)
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For men with lower-risk de novo metastatic non-castrate prostate cancer abiraterone may be offered, per STAMPEDE. (EB, H, M)
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The appropriate regimen is abiraterone 1000 mg with either prednisolone or prenisone 5 mg once daily until treatment(s) for mCRPC are initiated. (EB, H, S)
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Key Recommendation
Docetaxel and abiraterone are two separate standards of care for metastatic non-castrate prostate cancer. The use of both standards in combination or in series has not been assessed and therefore cannot be recommended. (EB, S)
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Qualifying Statements
For subsets of men with newly diagnosed metastatic non-castrate disease, treatment with abiraterone or docetaxel in combination with ADT should be offered on the basis of prolonging life relative to ADT alone. For docetaxel, the data are most compelling for men with de novo high volume metastatic non-castrate prostate cancer (defined as four or more bone metastases, one or more of which is outside of the spine or pelvis; and/or, the presence of any visceral disease) who are chemotherapy candidates. The appropriate regimen of docetaxel is six doses of docetaxel given every three weeks at 75 mg/m2 either alone (per CHAARTED) or with prednisolone per STAMPEDE). (EB, H, S)
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Men with de novo metastatic non-castrate high-risk disease per LATITUDE (two or more of the factors of Gleason score ≥8, ≥3 bone metastases, and measurable visceral disease) who are fit for treatment with abiraterone should receive ADT and AAP. Lower risk men may also be offered ADT and AAP (per STAMPEDE). The appropriate regimen is abiraterone 1000 mg with either prednisolone or prednisone 5 mg once daily. (EB, H, S)
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Recommendation Grading
Disclaimer
The information in this patient summary should not be used as a substitute for professional medical care or advice. Contact a health care provider if you have questions about your health.
Overview
Title
Optimizing Anticancer Therapy in Metastatic Non-Castrate Prostate Cancer
Authoring Organization
American Society of Clinical Oncology
Publication Month/Year
April 2, 2018
Last Updated Month/Year
April 1, 2024
Supplemental Implementation Tools
Document Type
Guideline
External Publication Status
Published
Country of Publication
US
Target Patient Population
Men with metastatic non-castrate prostate cancer being considered for treatment with ADT.
Target Provider Population
Urologists, radiation oncologists, medical oncologists, physician assistants, nurse practitioners, and other
Inclusion Criteria
Male, Adult, Older adult
Health Care Settings
Ambulatory, Hospital, Outpatient
Intended Users
Physician assistant, physician, nurse practitioner, nurse
Scope
Treatment
Diseases/Conditions (MeSH)
D011467 - Prostate, D017430 - Prostate-Specific Antigen
Keywords
androgen deprivation therapy, NCPC, Metastatic Prostate Cancer, Non-Castrate Prostate Cancer, androgen-deprivation therapy, ADT
Source Citation
DOI: 10.1200/JCO.2018.78.0619 Journal of Clinical Oncology 36, no. 15 (May 20, 2018) 1521-1539.