Editing Castrate-Resistant Prostate Cancer (section)

=== UrologySchool.com Summary ===

* Based on 2021 CUA CRPC Guidelines)

* '''<span style="color:#ff0000">General principles'''
** '''<span style="color:#ff0000">Whenever possible, clinical trials should remain the first choice in patients with CRPC.'''
** '''<span style="color:#ff0000">ADT should be continued'''
* '''<span style="color:#ff0000">Non-metastatic CRPC'''
** '''<span style="color:#ff0000">PSADT <10 months and life expectancy > 5 years (3):''' 
**#'''<span style="color:#ff0000">Apalutamide'''
**#'''<span style="color:#ff0000">Enzalutamide'''
**#'''<span style="color:#ff0000">Darolutamide'''
* '''<span style="color:#ff0000">Metastatic CRPC'''
** '''<span style="color:#ff0000">Asymptomatic or minimally symptomatic:'''
*** '''<span style="color:#ff0000">First-line: abiraterone or enzalutamide'''
*** '''<span style="color:#ff0000">Second-line: docetaxel'''
*** <span style="color:#ff0000">'''Minimally symptomatic defined as pain that is relieved by acetaminophen or a non-steroidal anti-inflammatory'''
** '''<span style="color:#ff0000">Moderate or severe symptoms:'''
*** '''<span style="color:#ff0000">First-line: docetaxel or radium-223'''
**** '''<span style="color:#ff0000">Radium-223 if pain due to bone metastases AND no visceral metastases, AND ≤3cm lymph node metastases'''
*** '''<span style="color:#ff0000">Abiraterone or enzalutamide in patients that cannot tolerate docetaxel'''
** '''<span style="color:#ff0000">Progression after docetaxel:'''
*** '''<span style="color:#ff0000">Cabazitaxel'''
*** '''<span style="color:#ff0000">Radium-223'''
*** '''<span style="color:#ff0000">If not received prior to docetaxel:'''
**** '''<span style="color:#ff0000">Abiraterone acetate'''
**** '''<span style="color:#ff0000">Enzalutamide'''
** <span style="color:#ff0000">'''PARP-inhibitors (2)'''
***<span style="color:#ff0000">'''Olaparib (before and after docetaxel in patients with homologous recombination repair (HRR) mutation who have progressed on a previous androgen receptor-axis-targeted therapy (ARAT) i.e., abiraterone, enzalutamide, apalutamide, darolutamide)'''
*** <span style="color:#ff0000">'''Rucaparib in patients with BRCA 1/2 associated with mCRPC who have progressed on a previous ARAT and a taxane-based chemotherapy'''
** '''<span style="color:#ff0000">Bone metastasis'''
*** '''<span style="color:#ff0000">Daily calcium and vitamin D supplementation'''
*** '''<span style="color:#ff0000">Denosumab (120 mg subcutaneous) or zoledronic acid (4 mg intravenous) every four weeks'''