Guidelines for the management of castrate-resistant prostate cancer.

Abstract

Secondary hormonal manipulations In patients who develop CRPC and who are relatively asymptomatic, secondary hormonal treatments may be attempted. Level 2 Evidence, Grade C recommendation To date, no study of secondary hormone treatment has demonstrated benefits in terms of survival, but most trials have been smaller and heavily confounded by the future treatments used. In patients treated with luteinizing-hormonereleasing hormone agonist monotherapy or who have had an orchidectomy, total androgen blockade (TAB) with testosterone antagonists, such as bicalutamide, can offer PSA responses in 30% to 35% of patients. For patients who progress on ADT without evidence of distant metastases, it is suggested to screen them for bone metastases and to monitor them for visceral metastases/progression with abdomen and chest imaging. Exact timing of imaging may be modulated using PSA doubling time. Imaging techniques most commonly used include nuclear bone scans and abdominal computed tomography and chest X-ray. The role of magnetic resonance imaging and positron emission tomography is still unclear. For patients who have undergone TAB, the antiandrogen could be discontinued to exclude an antiandrogen withdrawal response (AAWD). The introduction or changes of an AA or the use of ketoconazole has been reported to have transient PSA reductions in about 30% of patients. 3 Level