AMPLITUDE: Niraparib + Abiraterone/Prednisone + ADT in HRR-Altered mCSPC

Authored by Natalia Gandur, published on 2026-06-23 11:00:05.0

  1. 1. Confirm metastatic castration-sensitive prostate cancer (mCSPC)
    • 2. Order or confirm early germline and/or somatic HRR testing
      • 3. HRR alteration present?
        • Assess suitability for abiraterone/prednisone + ADT
          • 4. Fit for abiraterone/prednisone + ADT?
            • Use another standard mCSPC intensification pathway
            • PARP safety and access gate
              • CBC / anemia / marrow reserve • Blood pressure / cardiovascular risk • Liver function • Adherence / monitoring capacity • Local approval / access
              • Consider niraparib + abiraterone/prednisone + ADT
                • 6. Monitor
                  CBC, anemia, blood pressure, liver function, fatigue, adherence, PSA/imaging
                  • 7. At progression: re-stage and move to next-line sequencing / clinical trials
            • 5. Eligible and available?
              • Alternative standard mCSPC treatment
              • Consider niraparib + abiraterone/prednisone + ADT
                • 6. Monitor
                  CBC, anemia, blood pressure, liver function, fatigue, adherence, PSA/imaging
                  • 7. At progression: re-stage and move to next-line sequencing / clinical trials
        • No/Unknown
          • Standard mCSPC treatment pathway
            No PARP-based intensification
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