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Rapidly Evolving Treatment Landscape in Prostate Cancer









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


                                                                                                                      Radiation to primary + ADT
          Diagnosis
                                                              Active
                                                           Surveillance /
                                                           nmCSPC (M0)
                             Locally
                           advanced
                          at diagnosis
                                                                                                                                      Potential role of PARP inhibitors
                                           Surgery and/or                                           28%
                                           other definitive
                                             treatment                   nmCRPC (M0)                mCRPC                    1L mCRPC               2L mCRPC               3+L mCRPC
                                                                            CRPC


                                                                          ARAT + ADT                                           ARAT                   ARAT                   ARAT
                                                                       (Enza, Daro, Apa)                                     (Enza, Abi)            (Enza, Abi)            (Enza, Abi)

                                                                                                                                                     Taxane                  Taxane
          ADT for N0 M0: GnRH agonist ± AA or GnRH antagonist                                                                Docetaxel             (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
      *for HRRm who have progressed on ARAT                                                                              targeting

      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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