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).
