Table of Contents Table of Contents
Previous Page  85 / 112 Next Page
Show Menu
Previous Page 85 / 112 Next Page
Page Background


NCCN Guidelines for Patients


Prostate Cancer, Version 1.2016


Treatment guide: Systemic treatment

Castration-recurrent prostate cancer

Guide 21

addresses treatment for CRPC with

metastases. Despite that the cancer has returned

during hormone therapy, 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. You should keep

taking hormone therapy even if given other types of

treatment, such as immunotherapy.

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


If you have painful bone metastases, there are

treatments that may help to lessen the pain.

EBRT may be used when pain is limited to a

specific area or your bones are about to fracture.

Radiopharmaceuticals 89Sr (strontium) or 153Sm

(samarium) may relieve pain from widely spread bone

metastases that isn’t responding to other treatments.

Be aware that these treatments can cause your

bone marrow to make fewer blood cells, which could

prevent you from being treated with chemotherapy.

Radiation therapy used to relieve pain is called

supportive care. Supportive care (also called

palliative care) doesn’t aim to treat cancer but aims

to improve quality of life. Ask your treatment team for

a supportive care plan to address any symptoms you

have and other areas of need.


Sipuleucel-T is an immunotherapy drug that was

tested among men with metastatic CRPC. Research

found that men who took sipuleucel-T lived, on

average, 4 months longer than men not taking this

drug. Your results may be the same, better, or worse.

Sipuleucel-T is only advised for men who meet the

conditions listed in the Guide. Sipuleucel-T has not

been tested among men with metastases to the

internal organs (visceral disease).

For treatments other than sipuleucel-T, a drop in

PSA levels or improvement in imaging tests occurs if

treatment is working. Be aware that these signs don’t

occur during sipuleucel-T. Thus, don’t be discouraged

if your test results don’t improve.

There are other options if sipuleucel-T is not right for

you. These options for metastatic CRPC are based on

whether the cancer is or isn’t in the internal organs.

Some options in the two groups overlap. However,

the order of options differ based what’s best for that


Enzalutamide and abiraterone acetate

Enzalutamide and abiraterone acetate are newer

hormone therapies. Enzalutamide is an antiandrogen

that may work better than other antiandrogens. In a

clinical trial, it lowered PSA levels and extended life

by an average of about 5 months. Abiraterone acetate

is taken on an empty stomach with prednisone.

This drug has been shown to slow cancer growth.

Enzalutamide and abiraterone acetate have only

been tested among men with few or no cancer


Docetaxel and other chemotherapy

Chemotherapy with hormone therapy is another

treatment option. Docetaxel with prednisone on an

every-3-week schedule is the preferred treatment

option if the cancer is causing symptoms. It is not

often used when the cancer isn’t causing symptoms.

However, your doctor may suggest it if the cancer is

growing fast or may have spread to your liver.

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