Three15 162 Treatment of castration resistant prostate cancer B

Non metastatic CRPC 




RECOMMENDATION AGAINST - Systemic chemotherapy or immunotherapy outside the context of a clinical trial (Evidence Level Grade C)


Offer apalutamide, darolutamide or enzalutamide to patients with M0 CRPC and a high risk of developing metastasis (PSADT < 10 months) to prolong time to metastases. Strong, EAU

RCTS in M0 CRPC

• PROSPER - Enzalutamide vs placebo 
• SPARTAN - apalutamide vs placebo
• ARAMIS - darolutamide vs. placebo

• FDA Approval summary 
• - Apalutamide - For M0CRPC only 
• - Enzalutamide - M0CRPC+ M1CRPC 
• - Abiraterone - M1CRPC only

• Metastatic, no prior docetaxel, asymptomatic or minimally symptomatic 
• [@ DSP - Docetaxel, Symptoms, Performance status]

• Metastatic, no prior docetaxel, symptomatic, good performance status 

Metastatic, no prior docetaxel, symptomatic, poor performance status 



Sipuleucel T is used only for asymptomatic or minimally symptomatic setting - not for symptomatic patients, not in visceral disease, or patients requiring narcotic analgesics. 

Sipuleucel-T is a treatment option for patients with minimally or asymptomatic metastatic prostate cancer. Treatment is generally very safe. There is no evidence that sipuleucel-T treatment causes symptomatic relief, any clinically meaningful PSA declines, or delay in disease progression. The drug was approved based on a survival benefit compared with placebo.

• Prior docetaxel. good performance status 

• Prior docetaxel. poor performance status