Editing Castrate-Resistant Prostate Cancer (section)

====== Moderate or severe symptoms ======
*'''Docetaxel''' (75 mg/m2 every 3 weeks plus prednisone 5 mg PO BID) '''is recommended'''
* '''Radium-223 every 4 weeks for six cycles is recommended in patients with pain due to bone metastases and who do not have visceral metastases'''
** '''Radium-223 significantly improved overall survival and reduced symptomatic skeletal related events in patients with symptomatic mCRPC who had previously received docetaxel chemotherapy or were deemed unfit for docetaxel'''
* '''Abiraterone''' (1000 mg/day plus prednisone 5 mg twice daily) '''or enzalutamide''' (160mg/day) '''may be considered as first-line therapy in patients who cannot receive or refuse docetaxel'''
** NOTE: The studies in the chemo-naive setting did not include patients with moderate or severe symptoms; however, abiraterone and enzalutamide may be potential therapeutic options in patients who are deemed chemotherapy-ineligible or refuse chemotherapy
* '''Alternative therapies that have not demonstrated improvement in OS but can provide disease control, palliation, and improve quality of life include:'''
** '''Weekly docetaxel plus prednisone'''
** '''Mitoxantrone plus prednisone'''