Castration-Resistant Prostate Cancer

1. Clinicians should offer apalutamide or enzalutamide with continued androgen deprivation to patients with non-metastatic CRPC at high risk for developing metastatic disease. (Standard, A)

2. Clinicians may recommend observation with continued androgen deprivation to patients with non-metastatic CRPC at high risk for developing metastatic disease who do not want or cannot have one of the standard therapies. (Recommendation, C)

3. Clinicians may offer treatment with a second-generation androgen synthesis inhibitor (i.e. abiraterone plus prednisone) to select patients with non-metastatic CRPC at high risk for developing metastatic disease who do not want or cannot have one of the standard therapies and are unwilling to accept observation. (Option, C)

4. Clinicians should not offer systemic chemotherapy or immunotherapy to patients with non-metastatic CRPC outside the context of a clinical trial. (Recommendation, C)