NCCN Guidelines for Patients
: Prostate Cancer
Part 7: Treatment for advanced cancer
If your first ADT was surgical or medical castration,
starting CAB may help. Adding an antiandrogen may
lower testosterone levels. Ketoconazole, steroids, DES,
and other estrogens may also lower testosterone levels.
If you’re already on CAB, stopping your use of the
antiandrogen—known as antiandrogen withdrawal—may
help if the cancer cells are using the antiandrogen to
grow. This effect is called the antiandrogen withdrawal
response and usually last several months.
While on ADT, your doctor will monitor the
treatment results (see Parts 6.1 and 6.2). Read Part 7.3 if
the cancer metastasizes.
7.3 Castration-recurrent cancer with
Despite that the cancer has returned during ADT, it is
important to keep taking ADT. To treat the cancer, your
testosterone levels need to stay at castrate levels. To
do so, your doctor may keep you on your current ADT
regimen or may switch the type of ADT you are using.
You should keep taking ADT even if given other types of
treatment, such as chemotherapy.
Prostate cancer often spreads to the bones. When
prostate cancer invades your bones, they are at risk
for injury and disease. Such problems include bone
fractures, bone pain, and spinal cord compression.
Denosumab every 4 weeks or zoledronic acid every 3 to
4 weeks may help to prevent or delay these problems.
This chart lists treatment options for when the cancer has
spread far but isn’t causing symptoms. Sipuleucel-T is
an immunotherapy drug used for metastatic castration-
recurrent prostate cancer. Research found that men
taking sipuleucel-T lived, on average, 4 months longer
than men not taking this drug. Your results may be better
or worse. NCCN experts recommend sipuleucel-T with
ADT if the following describes you:
• In good health other than prostate cancer,
• Able to do most everyday life activities,
• Expected to live more than 6 months,
• No metastases to your liver, and
• Have no or very few symptoms of metastases.
• Abiraterone acetate,
• Antiandrogen withdrawal,
• DES or other estrogen, or