Page 6 - Advanced PC Booklet 17

Non-Metastatic Castration-Resistant Prostate Cancer (nmCRPC)
Testosterone ≤1.7 nmol/L, rising PSA (≥2 ng/mL) and no metastasis on CT(or MRI)/BS

Consider multidisciplinary consult

Continue ADT [L3sr]
• Calculate PSADT a
• Assess fracture risk and introduce/continue osteoporosis prevention measures as appropriate

High-Risk Not High-Risk
PSADT <10 mo AND PSADT >10 mo
a
a
Life expectancy >5 y

AR-targeted Therapy Refusal of/ Unsuitable Observation [L3WR] OR
st
Discontinue 1 -gen. AR antagonist for AR-targeted Therapy Secondary hormonal treatments [L3WR]
(eg, bicalutamide, flutamide) before Observation [L3WR] OR
initiating AR-targeted therapy [L3WR] 1 -gen AR antagonist [L3WR]
st
Apalutamide [L1SR] OR
Darolutamide [L1SR] OR
Enzalutamide [L1SR]

Monitoring Monitoring: Monitoring:
on AR-targeted Therapy:
• PSA/Testosterone q3mo • PSA/Testosterone q3-6mo
• PSA/Testosterone q3mo • Imaging q3-6mo [EO] or • Imagingb q6-12months depending
b
• Imaging based on response/ for symptoms on PSADT [L3WR], or for symptoms
b
progression (≤q12mo) or
for symptoms

If evidence of metastasis, follow mCRPC guidance

nmCRPC
a. PSA doubling time can be easily calculated using an online calculator https://www.mskcc.org/nomograms/prostate/psa_doubling_time.
b. Imaging techniques most commonly used: nuclear bone scans, abdominal/pelvic CT and chest x-ray. The role of PSMA-PET is still unclear and benefits unknown.