Guideline Recommendations

Androgen Deprivation Therapy

a. Androgen suppression should be continued with LHRH agonist or antagonist unless previous bilateral orchidectomy had been performed

b. Patients who progress on LHRH treatment or orchidectomy, should be started on an anti-androgen such as bicalutamide. Following further disease progression, the anti-androgen should be withdrawn

c. Alternative anti-androgen may be considered

Chemo-nave, Asymptomatic or Minimally Symptomatic

a. Clinical trial participation

b. Abiraterone + prednisolone

c. Ketoconazole + hydrocortisone

d. Enzalutamide

e. Observation

f. Androgen withdrawal and alternative anti-androgen therapy

Chemo-nave, Symptomatic, Good Performance Status

a. Clinical trial participation

b. Docetaxel (chemotherapy may be preferred if the patient failed to achieve a good response to initial hormonal therapy)

c. Abiraterone + prednisolone

d. Ketoconazole + hydrocortisone (clinicians may continue to recommend the use of ketoconazole on the basis of lower cost)

e. Enzalutamide

f. Radium-223 (in patients who decline chemotherapy and do not have visceral metastases)

Postchemo, Symptomatic, Good Performance Status

a. Clinical trial participation

b. Abiraterone + prednisolone

c. Ketoconazole + hydrocortisone (clinicians may continue to recommend the use of ketoconazole on the basis of lower cost)

d. Enzalutamide

e. Cabazitaxel

f. Re-challenge docetaxel

g. Radium-223 (in patients without visceral metastases)