UroGPO Medical Advisory Group Ø Neal Shore, MD Atlan<c Urology Clinics Ø Bryan Mehlhaff, MD Oregon Urology Ins<tute Ø Steve Bass, CFO Chesapeake Urology Ø Richard Harris, MD UroPartners Ø Larry Karsh, MD The Urology Center of Colorado Ø Richard David, MD Skyline Urology Ø Steve Dobbs, CEO Oklahoma Urology Specialists Ø Vahan Kassabian, MD Georgia Urology Ø Michael Fabrizio, MD Urology of Virginia
The informa<on contained within is the consensus of the UroGPO Medical Advisory Group and is intended only as a suggested guideline for treatment for mCRPC. UroGPO Members
are encouraged to review, discuss, and make adjustments as they see fit.
Ini<a<on of Androgen Depriva<on Therapy
INITIATE DIAGNOSTIC SURVEILLANCE
• PSA tes(ng every 3-‐6 months • Total PSA
• PSA Doubling Time (rising PSA) • Testosterone
CRPC if: • Testosterone < 50 ng/dl
AND • 2 consecu(ve PSA rises at
least 2 weeks apart AND /OR
• Progression on Imaging
Androgen Sensi(ve?
YES NO
INITIATE BONE HEALTH PLAN • Vitamin D • Calcium
• DXA Scan (osteopenia/low bone mass) • Consider Prolia
CONTINUE ADT • Consider Taxotere for high
volume METS
NO
YES POSITIVE FOR METS?
Castrate Resistant Prostate Cancer Con(nue BONE HEALTH PLAN
and DIAGNOSTIC SURVEILLANCE
Ini(ate RADIOGRAPHY or IMAGING as appropriate
Detectable METS?
Type of METS?
SEE RADAR PROTOCOL • Image, CT, Bone Scan when PSA
≥ 2 ng/mL • Imaging frequency if nega<ve for previous scan: Second scan when PSA = 5 ng/mL and every doubling of PSA level thereaUer (based on PSA every 3 months) • Consider clinical trials as
appropriate
NO YES
Bone see next page
Lymph Nodes/ SoY Tissue see next page
Visceral see next page
Lymph Nodes/ SoY
Tissue Bone Visceral
Treatments For Castrate Resistant Prostate Cancer w/METS
Bone Mets • Ini(ate Xgeva
Therapy
Symptoma<c • Xtandi or Zy<ga
• Xofigo Asymptoma<c (no bone pain)
• Provenge (recommended first treatment per updated NCCN
Guidelines)
• Xtandi or Zy<ga (Consider as adjuvant therapy with Provenge)
• Taxotere
Minimally Symptoma<c
• Provenge (recommended first treatment per updated
NCCN Guidelines)
• Xtandi or Zy<ga (Consider as adjuvant therapy
with Provenge)
• Taxotere
NSAID or analgesic use Narco(c use
• Xtandi or Zy<ga
• Xofigo (Reimaging to verify METS not required for reimbursement if previous posi(ve imaging exists)
• Taxotere • Xofigo
(Reimaging to verify METS not required for reimbursement if previous posi(ve imaging exists)
• Cabazitaxel
• Cabazitaxel • Cabazitaxel
• Taxotere
• Cabazitaxel
Treatments For Castrate Resistant Prostate Cancer w/METS
Lymph Nodes/ SoY Tissue Mets
Asymptoma<c or Minimally Symptoma<c Symptoma<c
• Xtandi or Zy<ga
Visceral Mets
• Xtandi or Zy<ga
• Provenge (recommended first treatment per updated NCCN
Guidelines)
• Xtandi or Zy<ga (Consider as adjuvant therapy with Provenge)
• Taxotere
• Taxotere
• Cabazitaxel
• Cabazitaxel
• Cabazitaxel
• Taxotere
Treatments For Castrate Resistant Prostate Cancer w/METS
