Treatment
ADT + Abiraterone
➤ For men with high-risk de novo metastatic non-castrate prostate cancer,
the addition of abiraterone to ADT should be offered, per LATITUDE.
(Strong Recommendation for high-risk disease patients as per LATITUDE;
EB-H)
➤ For men with lower-risk de novo metastatic non-castrate prostate cancer
abiraterone may be offered, per STAMPEDE. (Moderate Recommendation
for lower-risk patients per STAMPEDE; EB-H)
➤ The appropriate regimen is abiraterone 1000 mg with either
prednisolone or prednisone 5 mg once daily until treatment(s) for
mCRPC are initiated. (Strong Recommendation; EB-H)
Key Recommendation
➤ Docetaxel and abiraterone are two separate standards of care for
metastatic non-castrate prostate cancer. The use of both standards in
combination or in series has not been assessed and therefore cannot be
recommended. (Strong Recommendation; EB)
Qualifying Statements
➤ For subsets of men with newly diagnosed metastatic non-castrate
disease, treatment with abiraterone or docetaxel in combination with
ADT should be offered on the basis of prolonging life relative to ADT
alone. For docetaxel, the data are most compelling for men with de
novo high volume metastatic non-castrate prostate cancer (defined
as four or more bone metastases, one or more of which is outside of
the spine or pelvis; and/or, the presence of any visceral disease) who
are chemotherapy candidates. The appropriate regimen of docetaxel
is six doses of docetaxel given every three weeks at 75 mg/m
2
either
alone (per CHAARTED) or with prednisolone (per STAMPEDE). (Strong
Recommendation; EB-H)
➤ Men with de novo metastatic non-castrate high-risk disease per
LATITUDE (two or more of the factors of Gleason score ≥8, ≥3 bone
metastases, and measurable visceral disease) who are fit for treatment
with abiraterone should receive ADT and AAP. Lower risk men may also
be offered ADT and AAP (per STAMPEDE). The appropriate regimen is
abiraterone 1000 mg with either prednisolone or prednisone 5 mg once
daily. (Strong Recommendation; EB-H)
