management of advanced, metastatic prostatic carcinoma

Last edited 07/2021 and last reviewed 11/2021

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.