Page 3 - Advanced PC Booklet 17
P. 3
Advanced Prostate Cancer Treatment-Reference Guide
Advanced Prostate Cancer Treat/Refer Guide
Escalate Treatment Monitor a
De novo metastatic PC
• Treatment based on presence/absence • Imaging at PSA nadir, PSA
Never treated with ADT of high-volume/high-risk criteria progression, or with symptoms
(chemical or surgical Metastatic Start • Refer to algorithm and So, et al. • Image regularly during
castration) CSPC ADT CUA-CUOG Guidelines 2020 systemic therapy
Refer
History of localized PC metastatic
Previous ADT use for
localized PC for a defined
period (eg, 2 or 3 years)
without progression non-metastatic progression, castration-resistance
Monitor a Metastatic CRPC
Biochemical Recurrence Escalate Treatment G
(Non-metastatic CSPC) • If PSA progression on • Testosterone ≤1.7 nmol/L • Establish burden of disease
ADT, screen for bone metastasis AND • Treatment options based on
metastases (BS, imaging • Metastasis detected Continue prognosis, symptom severity,
abd/pelvis + chest) with conventional ADT prior therapy, and visceral
• Calculate PSADT imaging (BS, CT, MRI)
Start ADT metastatic burden
• If progression and no • With or without PSA • Refer to algorithm and Saad et
metastasis manage per progression al. CUA-GUOG Guidelines 2021
nmCRPC algorithm
Refer
progression, no metastasis
metastasis
Non-metastatic CRPC Escalate Treatment Monitor a
• Testosterone ≤1.7 nmol/L • Treatment options based on • On ARAT: Imaging based on
AND Continue risk status (PSADT and life response/ progression
• Rising PSA (≥2 ng/mL) ADT expectancy) (≤ q12mo) or for symptoms
AND [L3sr] • Refer to algorithm and Saad et • Not on ARAT: Imaging based
• No metastasis detected al. CUA-GUOG Guidelines 2021 on PSADT (see algorithm)
with conventional imaging
(BS, CT, MRI)
Refer
G Consider genetic testing for HRR mutations (eg, BRCA 1/2 and ATM)
a. Patients who do not respond to 1 -line ADT or who progress clinically or radiologically without significant PSA elevations may have neuroendocrine differentiation. Consider biopsy of accessible lesions.
st
These patients should be treated with combination chemotherapy. [L3wr]
