What are treatment options and decisions to make for metastatic prostate cancer

For metastatic prostate cancer, the National Comprehensive Cancer Network (NCCN) Guidelines provide evidence-based recommendations on treatment options and decisions. Here are some key points from the NCCN Guidelines for Patients on Prostate Cancer, specifically the "Prostate Cancer, Advanced" section:

Treatment Options:

• Hormone therapy (androgen deprivation therapy or ADT) is the primary systemic treatment for metastatic prostate cancer. This deprives the cancer of testosterone that can fuel its growth.
• Chemotherapy such as docetaxel may be added to ADT for metastatic hormone-sensitive disease.
• For castration-resistant metastatic disease after initial ADT, additional treatments like newer hormonal agents (abiraterone, enzalutamide), chemotherapy, radiopharmaceuticals, and immunotherapy may be options.
• Bone supportive care medications like denosumab or zoledronic acid are often used to prevent complications from bone metastases.

Important Decisions:

• Choosing between different ADT formulations (e.g. LHRH agonists, antagonists, orchiectomy)
• Timing and sequence of adding additional systemic therapies after ADT
• Evaluating clinical trial options
• Managing side effects and supportive care needs
• Discussing goals of care, treatment preferences, and quality of life considerations

The guidelines emphasize shared decision-making between patients and doctors based on cancer details, overall health status, side effect risks, and personal preferences. Multidisciplinary care from medical, radiation, and surgical oncologists is recommended.