Initial Treatment for Metastatic Prostate Cancer

Standard First-Line Treatment Options

The American Society of Clinical Oncology recommends androgen deprivation therapy (ADT) through surgical castration (bilateral orchiectomy) or medical castration (LHRH agonists) as the standard first-line treatment for metastatic prostate cancer 2, 3, 4
When starting LHRH agonist therapy, an antiandrogen should be given for 3-4 weeks initially to prevent testosterone flare, as recommended by the European Society for Medical Oncology 5, 6
Continuous ADT is recommended over intermittent ADT for metastatic hormone-naïve prostate cancer, according to the European Society for Medical Oncology 5, 6

Combined androgen blockade (CAB), which is the combination of medical castration and an antiandrogen, may provide a small survival benefit but with increased toxicity, as noted by the American Society of Clinical Oncology 1, 2
Patients willing to accept the increased toxicity of CAB for a small benefit in survival should be offered a nonsteroidal antiandrogen in addition to castrate therapy, as recommended by the American Society of Clinical Oncology 2, 3

For patients who progress to castration-resistant prostate cancer (CRPC), additional treatment options include abiraterone or enzalutamide for asymptomatic/mildly symptomatic men with chemotherapy-naïve metastatic CRPC, as recommended by the European Society for Medical Oncology 6
Docetaxel chemotherapy is recommended for symptomatic patients with metastatic CRPC and good performance status, according to the European Society for Medical Oncology 5, 6

Regular exercise has been shown to reduce fatigue and improve quality of life in men on ADT, as noted by the European Society for Medical Oncology 6
Shared decision-making between patients and physicians is necessary for optimal use of ADT, as patients may weigh the balance between favorable and adverse consequences of palliative ADT differently, according to the American Society of Clinical Oncology 1, 10