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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.