Page 13 - Practical Approaches to Managing Castration-Resistant Prostate Cancer (CRPC)

Patients with High-Risk nmCRPC

(PSADT ≤10 months) – See algorithm page 8
Treatment options
• Apalutamide + ADT [SPARTAN trial] OR
• Enzalutamide + ADT [PROSPER trial]
• If unsuitable or refuse therapy, consider first-generation androgen receptor
antagonist

Assessment and Monitoring
• Perform baseline assessment prior to starting apalutamide or enzalutamide
(see Baseline Assessment page 21)

• During therapy, monitor patients for disease progression (bone, lymph node,
and visceral metastases)
– PSA and testosterone every 3 months
– CT (abdomen/pelvis and chest) and BS based on response/progression
(at least every 12 months), or for symptoms
• For patients with high-risk disease not receiving apalutamide or enzalutamide
(unsuitable or refuse)
– PSA and testosterone every 3 months
– CT and BS every 3-6 months or for symptoms
• Triggers for changing therapy and/or referral
– If radiographic studies show metastatic disease, ensure castrate level of
testosterone, manage per mCRPC guidance
– If intolerable treatment-related toxicity not amenable to dose modification
or interruption, discontinue therapy and consider alternative treatment
options

Patients with Low-Risk (Non-High-Risk) nmCRPC

(PSADT >10 months) – See algorithm page 8

Treatment options
• Continue ADT + observation + monitoring
• Consider first-generation hormonal manipulation
Monitoring
• Monitor PSA and testosterone every 3-6 months
• CT and BS every 6-12 months, or for symptoms
• If PSA >20 ng/mL, image every 3-6 months
• Triggers for changing treatment strategy and/or referral
– If disease progresses to high-risk category (PSADT ≤10 months AND life
expectancy >5 years) without evidence of metastasis on conventional
imaging, manage according to High-Risk nmCRPC guidance
– If evidence of metastasis, follow mCRPC guidelines
– Consider multidisciplinary consult

10 Practical Approaches to Managing CRPC