Treatment

Document Overview

Design and created by Guideline Central in participation with the American Society of Clinical Oncology.

Systemic Therapy in Men with Metastatic Castration-Resistant Prostate Cancer

American Society of Clinical Oncology

Publication Date: Jan 20, 2026

Page Last Updated: Aug 17, 2026

Practical Information for Recommendation 1.1.3: Although there are limited data for abiraterone with prednisone, darolutamide, or apalutamide for patients with visceral disease in the mCRPC setting, these agents can be used as alternatives if there are concerns about side effects or drug interactions. Cabazitaxel may be used if allergic reactions or toxicity like peripheral neuropathy which precludes the use of docetaxel. The choice between an androgen receptor pathway inhibitor (ARPI) and chemotherapy may depend on the patient’s health, their ability to tolerate chemotherapy, the presence of symptoms and/or visceral disease, accessibility, cost, and the patient’s preference, especially if they are averse to chemotherapy.

(for patients regardless of HRR alterations).

for patients with disease progression despite previously mentioned options.

Recommendation Rating Definitions

Quality of Evidence
Term		Definitions
H	- High	We are very confident that the true effect lies close to that of the estimate of the effect
M	- Moderate	We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different.
L	- Low	Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect.
VL	- Very Low	We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect.
Ins	- Insufficient	Evidence is insufficient to discern the true magnitude and direction of the net effect. Further research may better inform the topic. Reliance on consensus opinion of experts may be reasonable to provide guidance on the topic until better evidence is available.

Strength of Recommendation
Term		Definitions
S	- Strong	In recommendations for an intervention, the desirable effects of an intervention outweigh its undesirable effects. In recommendations against an intervention, the undesirable effects of an intervention outweigh its desirable effects. All or almost all informed people would make the recommended choice for or against an intervention.

C W	- Conditional - Weak	In recommendations for an intervention, the desirable effects probably outweigh the undesirable effects, but appreciable uncertainty exists. In recommendations against an intervention, the undesirable effects probably outweigh the desirable effects, but appreciable uncertainty exists. Most informed people would choose the recommended course of action, but a substantial number would not.
GPS	Good Practice Statement	Good practice statements represent the consensus of the Expert Panel and are used when high quality indirect evidence is available, but it would not be a good use of the Expert Panel’s resources to conduct a formal systematic review
NR	- Not Rated

Brozek JL, Akl EA, Compalati E, et al: Grading quality of evidence and strength of recommendations in clinical practice guidelines part 3 of 3. The GRADE approach to developing recommendations. Allergy 66:588-95, 2011

Document Overview

Document Title: Systemic Therapy in Patients with Metastatic Castration-Resistant Prostate Cancer

Authoring Society: American Society of Clinical Oncology

Document Publication Date: Jan 20, 2026

Page Last Reviewed/Updated: Aug 17, 2026

Document Type: Guideline

Country of Publication: United States

Full Text Freely Available: Yes

Full Text Guideline: ascopubs.org/doi/10.1200/JCO-25-02693

Source Citation: Taplin, Mary-Ellen et al. “Systemic Therapy in Patients with Metastatic Castration-Resistant Prostate Cancer: ASCO Living Guideline, Version 2026.1.4.” Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 101200JCO2601898. 6 Aug. 2026, doi:10.1200/JCO-26-01898

Taplin M, Riaz IB, Rumble RB, et al. Systemic Therapy in Men with Metastatic Castration Resistant Prostate Cancer: ASCO Living Guideline Update, Version 2025.1. J Clin Oncol. 2026 Jan 20. doi: 10.1200/JCO-25-02693

Garje R, Riaz IB, Naqvi SA, et al. Systemic Therapy in Men with Metastatic Castration Resistant Prostate Cancer: ASCO Guideline Update. J Clin Oncol. 2025 May 2. doi: 10.1200/JCO-25-00007

Document Scope, Criteria, and Use Cases

Document Objectives: To provide evidence-based recommendations for patients with mCRPC (APMR).

Scope: Assessment and Screening, Management, Treatment

Diseases/Conditions (MeSH): D011467 - Prostate

Keywords: Castration-resistant Prostate cancer, Metastatic Castration Resistant Prostate Cancer, Metastatic Prostate Cancer, castration-resistant prostate cancer (CRPC), prostate cancer

Inclusion Criteria: Male, Adult, Older Adult

Health Care Settings: Ambulatory, Laboratory Services, Outpatient

Intended Users: Nurse, Nurse Practitioner, Physician, Physician Assistant

Systemic Therapy in Men with Metastatic Castration-Resistant Prostate Cancer

Treatment

Principles of Practice

Principles of Practice Statement 1

Principles of Practice Statement 2

Principles of Practice Statement 3

Principles of Practice Statement 4

Principles of Practice Statement 5

Principles of Practice Statement 6

Principles of Practice Statement 7

Patients Previously Treated With ADT Alone in Castration Sensitive or Nonmetastatic Castration-Resistant Prostate Cancer (CRPC) Setting and Whose Disease Has Progressed to mCRPC

Recommendation 1.1.1

Recommendation 1.1.2

Recommendation 1.1.3

Recommendation 1.1.4

Recommendation 1.1.5

Recommendation 1.1.7

Patients Previously Treated With ADT and an ARPI and Whose Disease Has Progressed to mCRPC

Recommendation 1.2.1

Recommendation 1.2.2

Recommendation 1.2.2.1

Recommendation 1.2.3

Patients Previously Treated With ADT and Docetaxel, and Whose Disease Has Progressed to Metastatic CRPC

Recommendation 1.3.1

Recommendation 1.3.2

Patients Previously Treated With ADT, ARPI and Docetaxel, and Whose Disease Has Progressed to Have Progressive Metastatic CRPC

Recommendation 1.4.1

Recommendation 1.4.2

Recommendation 1.4.3

Recommendation 1.4.4

Treatment Options For De Novo or Treatment-Emergent Small Cell Neuroendocrine Carcinoma of the Prostate

Recommendation 2.1

Recommendation 2.2

Recommendation 2.3

Recommendation 2.3.1

Assessing for Response While on Systemic Therapy for mCRPC

Recommendation 3.1

Recommended Scans for Response Assessment

Recommendation 3.2.1

Recommendation Rating Definitions

Document Overview

Document Scope, Criteria, and Use Cases