Management plan for symptomatic patients or patients with good performance status 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.

(B) Docetaxel treatment. Docetaxel is an anti-cancer drug that inhibits cancer cell division. Chemotherapy may be preferred if the patient failed to achieve a good response to initial hormone therapy.

(C) 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.

(D) Ketoconazole given together with hydrocortisone is recommended upon increase of prostate-specific antigen (PSA). 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. Your doctor may continue to recommend the use of ketoconazole on the basis of lower cost.

(E) Enzalutamide treatment is recommended. Enzalutamide is a drug that prevents male sex hormones from signalling prostate cancer cells to grow.

(F) Radium-223 treatment is recommended in patients who decline chemotherapy and do not have cancer that has spread to the internal organs. Radium-223 is more readily taken up by active cancer cells than normal cells. As a result, cancer cells are more likely to suffer from radiation from radium-223 than normal cells do. This depletes the number of cancer cells in the body.