Management plan for patients without symptoms, and who have not received chemotherapy

The following represent options that may be discussed with patients. Each option may differ in terms of approach, cost, visit frequency and side effects.

(A)Clinical trial participation is recommended.

(B) Abiraterone given together with prednisolone. Abiraterone slows the production of testosterone to inhibit the growth of prostate cancer cells. Prednisolone is taken together to reduce the side effects of abiraterone. This treatment improves survival, pain relief, health-related quality of life, delays worsening of pain and prevents cancer from spreading to the bones.

(C) Ketoconazole given together with hydrocortisone. An increased level of PSA correlates with presence of prostate cancer cells. Ketoconazole is a drug that will inhibit the production of male sex hormones, thus inhibiting the growth of prostate cancer cells. Hydrocortisone is taken together to reduce the side effects of ketoconazole.

(D) Enzalutamide treatment. Enzalutamide is a drug that prevents male sex hormones from signalling prostate cancer cells to grow. It improves survival and brings about a significant decrease in the risk of disease worsening that can be seen as increased size or number of tumours from radiographic imaging techniques like X-Rays, CT Scans or MRI scans.

(E) Active monitoring of the disease alone without drug treatment.

(F) Androgen withdrawal therapy and alternative anti-androgen therapy. Androgen withdrawal therapy refers to any form of treatment that reduces the amount of male sex hormones or androgens in the body. Anti-androgens are drugs that prevent androgens from working, thus preventing the growth of prostate cancer cells.