First line Metastatic Castration-Resistant Prostate Cancer (mCRPC)

Authored by Fred Saad, published on 2026-05-06 19:25:56.0

  1. First line mCRPC
    Preference for agents not previously received and a change in mechanism of action. Consider clinical trials.
    • Post ARPI
      • Docetaxel
      • If symptomatic + no visceral metastases: Radium-223*
    • Post ARPI and docetaxel
      • If PSMA-expressing lesions: 177Lu-PSMA-617 (up to six cycles)
      • Cabazitaxel
        • If symptomatic + no visceral metastases: Radium-223*
    • Post docetaxel
      • Abiraterone, or Enzalutamide, or Cabazitaxel
      • If symptomatic + no visceral metastases: Radium-223*
    • HRR mutation
      • No prior ARPI
        • Niraparib + Abi, or Olaparib + Abi, or Talazoparib + Enza
      • Prior ARPI
        • Olaparib
    • Post ADT alone
      • Abiraterone, or Enzalutamide, or Docetaxel
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