NCCN Guidelines for Patients® | Prostate Cancer - page 65

NCCN Guidelines for Patients
: Prostate Cancer
Version 1.2014
Part 7: Treatment for advanced cancer
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7.2 Castration-recurrent cancer without metastases
Treatment options
Clinical trial (preferred),
Observation, or
Secondary ADT
• Antiandrogen,
• Antiandrogen withdrawal,
• Ketoconazole,
• Corticosteroids, or
• DES or other estrogen
This chart lists treatment options for when the cancer isn’t responding to first-
time ADT. Castration-recurrent prostate cancer may occur because androgen
receptors in the cancer cells become active again. Changes in androgen
receptors, called mutations, allow cancer cells to receive signals from unusual
sources that activate growth. One unusual source is antiandrogens. Activation
of androgen receptors may also occur because the cancer cells or nearby cells
start to make testosterone.
When tests find no proof of metastases, there are three options. Joining a
clinical trial is the preferred option. A clinical trial is a type of research that
studies how well a treatment works. Because of clinical trials, the treatments in
this booklet are now widely used to help men with prostate cancer.
The second option is observation. Instead of changing your treatment, you may
want to continue observation until the proof for cancer growth is stronger. The
third option is secondary ADT, especially if the PSADT is less than 10 months.
Secondary ADT may help control cancer growth if the androgen receptors are
active. However, secondary therapies haven’t been shown to extend life when
given before chemotherapy.
= Androgen
deprivation therapy
= Combined androgen
= Diethylstilbestrol
= Digital rectal exam
= Luteinizing
hormone-releasing hormone
= Prostate-specific
Read Part 4 for more
information on
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