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NCCN Guidelines for Patients


Prostate Cancer, Version 1.2016

Guide 23

lists options for M1 disease if docetaxel

fails. 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.

There is no strong agreement on what is the next

best treatment. Abiraterone with prednisone or

enzalutamide has been shown to slightly prolong

life when used after docetaxel. Similar results were

found with cabazitaxel plus prednisone. However,

cabazitaxel can cause severe side effects so close

monitoring is needed. You shouldn’t use cabazitaxel if

you have liver problems.

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


After docetaxel fails, your doctor may want you

to take docetaxel again. This is called docetaxel

rechallenge. Whether you took docetaxel or not,

other recommendations include chemotherapy

and secondary hormone therapy. If you can’t take

a taxane-based chemotherapy like cabazitaxel,

mitoxantrone is an option. Mitoxantrone and other

chemotherapy drugs haven’t extended the lives of

men after docetaxel failure but may help you feel

better by reducing symptoms.

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.


Treatment guide: Systemic treatment

Castration-recurrent prostate cancer