Page 12 - Practical Approaches to Managing Castration-Resistant Prostate Cancer (CRPC)

Management of Patients with nmCRPC

nmCRPC Patient Assessment

• Physical exam
• Patient history/comorbidities (see Baseline Assessment page 21)

• Lab tests
• Screen for bone metastasis (bone scan) and lymph node and visceral
metastases/progression (CT of abdomen/pelvis and chest)

Management Principles in Patients with Low-Risk
(Non-High-Risk) or High-Risk Disease

• Ensure castrate levels of testosterone

• Initial CRPC management strategies
– Consider adding or changing of first-generation androgen receptor
antagonist (eg, bicalutamide) – potential short-term PSA response
– If current therapy involves total androgen blockage (TAB), test for anti-
androgen withdrawal (AAWD) response

• Maintain ADT throughout nmCRPC state
– Discontinue any first-generation androgen receptor antagonist such as
bicalutamide or flutamide before initiating apalutamide or enzalutamide
• Consider a multidisciplinary consult

• Consider clinical trial eligibility

Practical Approaches to Managing CRPC 9