NCCN Guidelines for Patients
Prostate Cancer, Version 1.2016
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