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85

NCCN Guidelines for Patients

®

Prostate Cancer, Version 1.2016

7

Treatment guide: Systemic treatment

Castration-recurrent prostate cancer

Guide 22. Treatment after enzalutamide or abiraterone

Options if no metastases in internal organs

• Docetaxel with prednisone

• Abiraterone acetate with prednisone

• Enzalutamide

• Radium-223 for bone metastases causing

symptoms

• Sipuleucel-T

• Clinical trial

• Secondary hormone therapy

◦◦ Antiandrogen

◦◦ Antiandrogen withdrawal

◦◦ Ketoconazole ± hydrocortisone

◦◦ Corticosteroids

◦◦ DES or other estrogen

• Best supportive care

Options if metastases in internal organs

• Docetaxel with prednisone

• Clinical trial

• Abiraterone acetate with prednisone

• Enzalutamide

• Secondary hormone therapy

◦◦ Antiandrogen

◦◦ Antiandrogen withdrawal

◦◦ Ketoconazole ± hydrocortisone

◦◦ Corticosteroids

◦◦ DES or other estrogen

• Best supportive care

Guide 22

lists treatment options for M1 disease

following enzalutamide or abiraterone. These

options 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 group.

Docetaxel with prednisone on an every-3-week

schedule is preferred for cancer that is causing

symptoms. Abiraterone with prednisone can

be received if you took enzalutamide before

and enzalutamide can be received if you took

abiraterone acetate before.

Radium-223 is an option for metastases that occur

mostly in the bones and not in the internal organs.

Sipuleucel-T may also be used for CRPC that

hasn’t spread to internal organs. Read Guide 21

for more details.

Other options to consider are clinical trials and

secondary hormone therapy. Joining a clinical trial

is strongly supported. It may give you access to

new treatments. Secondary hormone therapy may

have minor benefits. All men with CRPC should

receive best supportive care.