Page 2 - mCSPC Card 07

General Management Principles for Metastatic

Castration-Naïve and Castration-Sensitive

Prostate Cancer

• Most patients should receive some form of systemic therapy in addition to ADT

• For patients who are candidates for systemic therapy in conjunction with ADT,
perform a thorough baseline assessment
• Choice of treatment is dependent on several factors, including:
– Patient characteristics (eg, life expectancy, age, comorbidities)
– Tumour characteristics (eg, disease burden)
– Risk of neuroendocrine dedifferentiation
– Patient expectations
– Quality of life

• Maintain ADT throughout treatment
• Patients with de novo metastatic disease may have a shorter duration of hormone
sensitivity and worse survival compared with primary progressive metastatic disease,
suggesting a more aggressive disease course
• Chemotherapy may be better suited for patients with:
– High-volume metastatic disease and discordant PSA
– High-volume visceral metastasis (particularly liver metastases indicating potential
neuroendocrine dedifferentiation)

• Further data are required to determine the benefit of combining androgen receptor-axis
targeted therapy with chemotherapy

• Treatment sequencing should give preference to agents with a different mechanism of
action from the prior line of therapy

• Referral to a specialized tertiary centre for GU multidisciplinary consult should be
considered

• If no access to multidisciplinary conference, patients should be referred to a urologic
oncologist
• Because advanced disease remains non-curative, encourage patients to participate in
clinical trials

ADT = androgen deprivation therapy; EBRT = external beam radiation therapy; GU = genitourinary; mCRPC = metastatic castration-resistant
prostate cancer; mCSPC = metastatic castration-sensitive prostate cancer; PSA = prostate-specific antigen.

This tool card has been made possible through funding from Astellas Pharma Canada, Inc. in the form of an educational grant.

076-5597-PM-EN