ASCO GUIDELINES Bundle

Noncastrate Advanced, Recurrent or Metastatic Prostate Cancer Initial Management

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Key Points ➤ This guideline focuses on men with advanced, recurrent, or metastatic prostate cancer and noncastrate testosterone levels whose disease is not yet castration-resistant, including those with biochemical recurrence only. ➤ The future of noncastrate advanced, recurrent, or metastatic prostate cancer care is predicted to include highly personalized treatment plans based on advanced genetic testing, next generation imaging, and the availability of highly predictive biomarkers. Treatment Initial Treatment Recommendation 1.0 ➤ Docetaxel, abiraterone, enzalutamide, or apalutamide, each when administered with ADT, represent four separate standards of care (SOCs) for noncastrate metastatic prostate cancer. The use of any of these agents in any particular combination or in any particular series cannot yet be recommended (Strong Recommendation; EB-B-N/A). Androgen Deprivation Therapy (ADT) Plus Docetaxel Recommendation 1.1 ➤ For men with metastatic noncastrate prostate cancer with high-volume disease (HVD) as defined per CHAARTED who are candidates for treatment with chemotherapy, the addition of docetaxel to ADT should be offered (Strong recommendation [for patients with HVD]; EB-B-H). Recommendation 1.2 ➤ For patients with low-volume metastatic disease (LVD) as defined per CHAARTED who are candidates for chemotherapy, docetaxel plus ADT should NOT be offered (Strong recommendation [for patients with LVD]; EB-B-H). Recommendation 1.3 ➤ The recommended regimen of docetaxel for men with metastatic noncastrate prostate cancer is six doses administered at 3 week intervals at 75 mg/m 2 either alone (per CHAARTED) or with prednisolone (per STAMPEDE) (Strong recommendation; EB-B-H).

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