Table 1.
Current systemic treatment options for metastatic prostate cancer.
| CASTRATION-SENSITIVE PROSTATE CANCER | |
|---|---|
|
ADT •LHRH agonists vs. antagonists •Continuous vs. intermittent |
•Mainstay of therapy for mCSPC. •No clear superiority of LHRH agonists or antagonists. •Intermittent ADT not proven to be non-inferior to continuous47. •Should be used continuously in the setting of mCRPC. |
| ADT plus Docetaxel | • Two RCTs and meta-analysis demonstrating improved outcomes for de novo mCSPC, including OS12,13,48. |
| ADT plus Abiraterone and prednisone | • Two RCTs demonstrating significant improvements in outcomes for de novo mCSPC, including OS14,15. |
| CASTRATION-RESISTANT PROSTATE CANCER | |
|
AR-signaling inhibitors •Abiraterone / prednisone •Enzalutamide |
•Both with RCTs demonstrating significant improvements in OS and QoL in pre- and post-chemo settings4–7. •Sequential use not proven to improve clinically meaningful outcomes49. |
|
Taxane-based chemotherapy •Docetaxel •Cabazitaxel |
•RTCs demonstrating improvements in clinically meaningful outcomes8,9. •Cabazitaxel approved for patients previously treated with docetaxel9. •Both taxanes retain activity in patients with AR-V733,34. |
|
Radiopharmaceuticals • Radium-223 |
•1st radiopharmaceutical to demonstrate OS benefit10. •Can be used in pre- and post-chemo settings, and in combination with osteoclast-inhibitory agents. |
|
Immunotherapy • Sipuleucel-T |
• Despite OS improvement demonstrated in one RCT, no benefit in terms of PSA decline, objective response or PFS11. |
Abbreviations: ADT: androgen deprivation therapy; aPC: advanced prostate cancer; CRPC: castration-resistant prostate cancer; RCT: randomized clinical trials; OS: overall survival; QoL: quality of life; PFS: progression-free survival; chemo: chemotherapy; PSA: prostatic specific antigen.