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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


  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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