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80

NCCN Guidelines for Patients

®

Prostate Cancer, Version 1.2016

Castration-recurrent prostate cancer

Guide 20. Treatment for M0 stage

What are my options?

• Clinical trial (preferred)

• Observation

• Secondary hormone therapy

◦◦ Antiandrogen

◦◦ Antiandrogen withdrawal

◦◦ Ketoconazole ± hydrocortisone

◦◦ Corticosteroids

◦◦ DES or other estrogen

7

Treatment guide: Systemic treatment

Castration-recurrent prostate cancer

In this section, options for CRPC (

c

astration-

r

ecurrent

p

rostate

c

ancer) are discussed. Options

are based on if the cancer is M0 or M1 stage.

Treatment for M0 is addressed below. Treatment

for M1 is listed in Guides 21, 22, and 23.

Despite low testosterone levels, CRPC 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.

Despite that the cancer has returned during ADT,

it is important to keep taking it. To treat the cancer,

your testosterone levels need to stay at castrate

levels. Castrate levels are less than 50 ng/dL. To

do so, your doctor may keep you on your current

treatment or may switch the type of hormone

therapy you are using.