NCCN Guidelines for Patients® | Prostate Cancer - page 68

NCCN Guidelines for Patients
: Prostate Cancer
Version 1.2014
Part 7: Treatment for advanced cancer
With symptoms
Radium-223 for bone metastases,
Treatment options
Abiraterone acetate,
Supportive care, or
Clinical trial
Abiraterone acetate or enzalutamide,
Salvage chemotherapy,
Docetaxel rechallenge,
Secondary ADT,
• Antiandrogen,
• Antiandrogen withdrawal,
• Ketoconazole,
• Corticosteroids, or
• DES or other estrogen
Sipuleucel-T, or
Clinical trial
If cancer grows
Radium-223 for bone metastases,
This chart lists treatment options for when the cancer has
spread far and is causing symptoms. When the cancer
is this advanced, chemotherapy with ADT may help.
Docetaxel with prednisone on an every-3-week schedule
is the preferred treatment option. This regimen extended
survival by an average of about 2 months. Research has
found that men taking docetaxel live longer. Men were
given up to 10 cycles if no cancer growth was noted and
no severe side effects occurred. If your PSA level rises
while taking docetaxel, it doesn’t mean without doubt that
the treatment has failed. Your doctor may suggest that you
keep taking docetaxel until it is clear that the cancer has
grown or side effects are too severe.
If you’re unable to take docetaxel, four other treatments
are recommended. Very new research supports use of
radium-223 if the cancer has metastasized to the bone
but not to the internal organs (visceral metastases). In
research studies, radium-223 was shown to extend the
lives of men by an average of about 4 months. Your results
may be better or worse. Radium-223 also reduced the
pain caused by the bone metastases and the use of pain
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