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NCCN Guidelines for Patients


Prostate Cancer, Version 1.2016

Guide 20

lists treatments for CRPC with no

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

book are now widely used to help men with prostate


The second option is observation. Instead of

changing your treatment, you may want to continue

observation until the proof for cancer growth is

stronger. This is especially true if the PSA doubling

time was 10 months or longer.

The third option is secondary hormone therapy,

especially if the PSA doubling time is less than 10

months. Secondary hormone therapy may help

control cancer growth if the androgen receptors

are active. However, secondary therapies haven’t

been shown to extend life when given before


If your first hormone therapy was surgical or medical

castration, starting CAB may help. Adding an

antiandrogen may lower testosterone levels. Other

medicines that may lower testosterone levels include

ketoconazole with or without hydrocortisone, steroids,

DES, and other estrogens.

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 lasts

several months.


Treatment guide: Systemic treatment

Castration-recurrent prostate cancer