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Management of advanced, metastatic prostatic carcinoma

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

The management options include:

  • bilateral orchidectomy
    • healthcare professionals should offer bilateral orchidectomy to all men with metastatic prostate cancer as an alternative to continuous LHRH agonist therapy (1)

  • LHRH agonist

  • anti-androgen monotherapy
    • do not offer combined androgen blockade as a first-line treatment for men with metastatic prostate cancer
    • metastatic prostate cancer who are willing to accept the adverse impact on overall survival and gynaecomastia in the hope of retaining sexual function, anti-androgen monotherapy with bicalutamide should be offered (1)
    • begin androgen deprivation therapy and stop bicalutamide treatment in men with metastatic prostate cancer who are taking bicalutamide monotherapy and who do not maintain satisfactory sexual function
  • maximal androgen blockade:
    • bilateral orchidectomy plus
    • anti-androgen
    • combined androgen blockade is not recommended as a first-line treatment for men with metastatic prostate cancer (1)

  • chemotherapy:
    • docetaxel is recommended, within its licensed indications, as a treatment option for men with hormone-refractory metastatic prostate cancer only if their Karnofsky performance-status score is 60% or more (2)

  • bisphosphonates
    • bisphosphonates for pain relief may be considered for men with hormone-refractory prostate cancer when other treatments (including analgesics and palliative radiotherapy) have failed
      • should not be used routinely to prevent osteoporosis in men with prostate cancer receiving androgen withdrawal therapy

Reference:

  1. NICE (May 2019).Prostate cancer Diagnosis and treatment
  2. NICE (June 2006). Docetaxel for the treatment of hormone-refractory metastatic prostate cancer.

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