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Prostate Cancer Patient Journey








                                                                                                                     ARAT (Enza, Abi, Apa) + ADT
                             Metastatic                                                           mCSPC
                            at diagnosis                                                     (including de novo)
                                                                                                                          Docetaxel + ADT

                                                                                                                     Radiation to primary + ADT
            Diagnosis
                                                         Active Surveillance /
                                                           nmCSPC (M0)

                        Locally advanced
                          at diagnosis
                                                                                                                                     Potential role of PARP inhibitors

                                       Surgery and/or other
                                        definitive treatment
                                                                       nmCRPC (M0) CRPC           mCRPC                      1L mCRPC                 2L mCRPC                3+L mCRPC


                                                                          ARAT + ADT                                           ARAT                     ARAT                     ARAT
                                                                        (Enza, Daro, Apa)                                    (Enza, Abi)              (Enza, Abi)             (Enza, Abi)
                                                                                                                                                       Taxane                   Taxane
                                                                                                                             Docetaxel
         ADT for N0 M0: GnRH agonist ± AA or GnRH antagonist                                                                                        (Doce, Cabaz)            (Doce, Cabaz)
         ADT for N1 M0: GnRH agonist ± AA or GnRH antagonist or orchiectomy
                                                                                                                            PARPi (Ola*)             PARPi (Ola*)             PARPi (Ola*)


                                                                                                                            Radium 223               Radium 223               Radium 223


                                                                                                                        all on a background of ADT (GnRH ± AA or orchiectomy), palliative radiation
                                                                                                                        therapy,  supportive agents, eg, G-CSF, antiemetics, bone targeting

  *for HRRm who have progressed on ARAT

  Abi, abiraterone; ARAT, androgen receptor-axis-targeted therapies; AA, antiandrogen; Apa, apalutamide; Cabaz, cabazitaxel; Daro, darolutamide; Doce, Docetaxel; Enza, enzalutamide; GnRH, gonadotropin-releasing hormone ; G-CSF, granulocyte colony-stimulating factor; HRR, homologous
  recombination repair; mCRPC, metastatic castration-resistant prostate cancer; mCSPC, metastatic castration-sensitive PC; Ola, olaparib; PARP, poly(ADP-ribose) polymerase inhibitor. 1. NCCN Clinical Guidelines in Oncology. Prostate Cancer v3.2020. 2. Parker C et al. Ann Oncol 2020;31:1119-24.
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