Second-Line Hormonal Therapy for Men With Chemotherapy-Naïve Castration-Resistant Prostate Cancer
Abiraterone acetate plus prednisone or enzalutamide should be offered for second-line hormonal treatment following first-line hormonal treatment failure for chemotherapy-naïve men who develop CRPC and have radiographic evidence of metastases (M1a/M1s CRPC) because these agents have been shown to significantly increase radiographic progession-free survival (rPFS) and overall survival (OS). (Evidence-based, Strong recommendation)
Palliative care should be offered to all chemotherapy-naïve men with M1 CRPC, particularly those exhibiting symptoms or decreased QOL.
For chemotherapy-naïve patients with M0 CRCP at high risk of developing metastases (rapid PSA doubling time or velocity), second-line hormonal therapies which lower PSA values or slow the rate of rise may be offered, preferably in a clinical trial setting where available, following a discussion with the patient about the limited scientific evidence, potential harms, benefits, cost, and patient preferences.
There are no data to support the use of second-line hormonal therapies for chemotherapy-naïve men with M0 CRPC who are at low risk of developing metastases (low-risk is defined as low PSA and slow PSA doubling time).
Algorithm for Second-line Hormonal CRPC Treatment
Second-Line Hormonal Therapy for Men With Chemotherapy-Naïve, Castration-Resistant Prostate Cancer
April 25, 2017
Last Updated Month/Year
June 9, 2022
Supplemental Implementation Tools
External Publication Status
Country of Publication
Target Patient Population
Chemotherapy-naïve men with CRPC
Target Provider Population
Urologists, radiation, and medical oncologists.
Male, Adult, Older adult
Health Care Settings
Ambulatory, Hospital, Outpatient
Nurse, nurse practitioner, physician, physician assistant
Assessment and screening, Management
castration-resistant prostate cancer (CRPC), hormonal therapy, CRPC, Second-line
DOI: 10.1200/JCO.2017.72.8030 Journal of Clinical Oncology 35, no. 17 (June 10, 2017) 1952-1964.