NCCN Guidelines Insights: Prostate Cancer, Version 1.2021

Featured Updates to the NCCN Guidelines

Authors:
Edward Schaeffer Robert H. Lurie Comprehensive Cancer Center of Northwestern University;

Search for other papers by Edward Schaeffer in
Current site
Google Scholar
PubMed Close
 MD, PhD
,
Sandy Srinivas Stanford Cancer Institute;

Search for other papers by Sandy Srinivas in
Current site
Google Scholar
PubMed Close
 MD
,
Emmanuel S. Antonarakis The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins;

Search for other papers by Emmanuel S. Antonarakis in
Current site
Google Scholar
PubMed Close
 MD
,
Andrew J. Armstrong Duke Cancer Institute;

Search for other papers by Andrew J. Armstrong in
Current site
Google Scholar
PubMed Close
 MD
,
Justin E. Bekelman Abramson Cancer Center at the University of Pennsylvania;

Search for other papers by Justin E. Bekelman in
Current site
Google Scholar
PubMed Close
 MD
,
Heather Cheng Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance;

Search for other papers by Heather Cheng in
Current site
Google Scholar
PubMed Close
 MD, PhD
,
Anthony Victor D’Amico Dana-Farber/Brigham and Women’s Cancer Center | Massachusetts General Hospital Cancer Center;

Search for other papers by Anthony Victor D’Amico in
Current site
Google Scholar
PubMed Close
 MD, PhD
,
Brian J. Davis Mayo Clinic Cancer Center;

Search for other papers by Brian J. Davis in
Current site
Google Scholar
PubMed Close
 MD, PhD
,
Neil Desai UT Southwestern Simmons Comprehensive Cancer Center;

Search for other papers by Neil Desai in
Current site
Google Scholar
PubMed Close
 MD
,
Tanya Dorff City of Hope National Cancer Center;

Search for other papers by Tanya Dorff in
Current site
Google Scholar
PubMed Close
 MD
,
James A. Eastham Memorial Sloan Kettering Cancer Center;

Search for other papers by James A. Eastham in
Current site
Google Scholar
PubMed Close
 MD
,
Thomas A. Farrington Prostate Health Education Network (PHEN);

Search for other papers by Thomas A. Farrington in
Current site
Google Scholar
PubMed Close
,
Xin Gao Dana-Farber/Brigham and Women’s Cancer Center | Massachusetts General Hospital Cancer Center;

Search for other papers by Xin Gao in
Current site
Google Scholar
PubMed Close
 MD
,
Eric Mark Horwitz Fox Chase Cancer Center;

Search for other papers by Eric Mark Horwitz in
Current site
Google Scholar
PubMed Close
 MD
,
Joseph E. Ippolito Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine;

Search for other papers by Joseph E. Ippolito in
Current site
Google Scholar
PubMed Close
 MD, PhD
,
Michael R. Kuettel Roswell Park Comprehensive Cancer Center;

Search for other papers by Michael R. Kuettel in
Current site
Google Scholar
PubMed Close
 MD, MBA, PhD
,
Joshua M. Lang University of Wisconsin Carbone Cancer Center;

Search for other papers by Joshua M. Lang in
Current site
Google Scholar
PubMed Close
 MD
,
Rana McKay UC San Diego Moores Cancer Center;

Search for other papers by Rana McKay in
Current site
Google Scholar
PubMed Close
 MD
,
Jesse McKenney Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute;

Search for other papers by Jesse McKenney in
Current site
Google Scholar
PubMed Close
 MD
,
George Netto O'Neal Comprehensive Cancer Center at UAB;

Search for other papers by George Netto in
Current site
Google Scholar
PubMed Close
 MD
,
David F. Penson Vanderbilt-Ingram Cancer Center;

Search for other papers by David F. Penson in
Current site
Google Scholar
PubMed Close
 MD, MPH
,
Julio M. Pow-Sang Moffitt Cancer Center;

Search for other papers by Julio M. Pow-Sang in
Current site
Google Scholar
PubMed Close
 MD
,
Robert Reiter UCLA Jonsson Comprehensive Cancer Center;

Search for other papers by Robert Reiter in
Current site
Google Scholar
PubMed Close
 MD
,
Sylvia Richey St. Jude Children’s Research Hospital/The University of Tennessee Health Science Center;

Search for other papers by Sylvia Richey in
Current site
Google Scholar
PubMed Close
 MD
,
Mack Roach, III UCSF Helen Diller Family Comprehensive Cancer Center;

Search for other papers by Mack Roach, III in
Current site
Google Scholar
PubMed Close
 MD
,
Stan Rosenfeld University of California San Francisco Patient Services Committee Chair;

Search for other papers by Stan Rosenfeld in
Current site
Google Scholar
PubMed Close
,
Ahmad Shabsigh The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute;

Search for other papers by Ahmad Shabsigh in
Current site
Google Scholar
PubMed Close
 MD
,
Daniel E. Spratt University of Michigan Rogel Cancer Center;

Search for other papers by Daniel E. Spratt in
Current site
Google Scholar
PubMed Close
 MD
,
Benjamin A. Teply Fred & Pamela Buffett Cancer Center;

Search for other papers by Benjamin A. Teply in
Current site
Google Scholar
PubMed Close
 MD
,
Jonathan Tward Huntsman Cancer Institute at the University of Utah; and

Search for other papers by Jonathan Tward in
Current site
Google Scholar
PubMed Close
 MD, PhD
,
Dorothy A. Shead National Comprehensive Cancer Network.

Search for other papers by Dorothy A. Shead in
Current site
Google Scholar
PubMed Close
 MS
, and
Deborah A. Freedman-Cass National Comprehensive Cancer Network.

Search for other papers by Deborah A. Freedman-Cass in
Current site
Google Scholar
PubMed Close
 PhD
Volume/Issue:
Volume 19: Issue 2
Online Publication Date:
02 Feb 2021
DOI:
https://doi.org/10.6004/jnccn.2021.0008
Restricted access

The NCCN Guidelines for Prostate Cancer address staging and risk assessment after a prostate cancer diagnosis and include management options for localized, regional, and metastatic disease. Recommendations for disease monitoring and treatment of recurrent disease are also included. The NCCN Prostate Cancer Panel meets annually to reevaluate and update their recommendations based on new clinical data and input from within NCCN Member Institutions and from external entities. This article summarizes the panel’s discussions for the 2021 update of the guidelines with regard to systemic therapy for metastatic castration-resistant prostate cancer.

  • Collapse
  • Expand
Print ISSN:
1540-1405
Online ISSN:
1540-1413
Publisher:
National Comprehensive Cancer Network
Cover Journal of the National Comprehensive Cancer Network
  • 1.

    Siegel RL, Miller KD, Jemal A. Cancer statistics, 2020. CA Cancer J Clin 2020;70:7–30.

  • 2.

    Herget KA, Patel DP, Hanson HA, et al.. Recent decline in prostate cancer incidence in the United States, by age, stage, and Gleason score. Cancer Med 2016;5:136–141.

  • 3.

    Kohler BA, Sherman RL, Howlader N, et al.. Annual report to the nation on the status of cancer, 1975-2011, featuring incidence of breast cancer subtypes by race/ethnicity, poverty, and state. J Natl Cancer Inst 2015;107:djv048.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 4.

    Negoita S, Feuer EJ, Mariotto A, et al.. Annual Report to the Nation on the Status of Cancer, part II: recent changes in prostate cancer trends and disease characteristics. Cancer 2018;124:2801–2814.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 5.

    Scher HI, Halabi S, Tannock I, et al.. Design and end points of clinical trials for patients with progressive prostate cancer and castrate levels of testosterone: recommendations of the Prostate Cancer Clinical Trials Working Group. J Clin Oncol 2008;26:1148–1159.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 6.

    Apalutamide [package insert]. Horsham, PA: Janssen Products, LP; 2019.

  • 7.

    Enzalutamide [package insert]. Northbrook, IL: Astellas Pharma US, Inc.; 2019.

    • PubMed
    • Export Citation
  • 8.

    Darolutamide [package insert]. Whippany, NJ: Bayer HealthCare Pharmaceuticals Inc; 2019.

    • PubMed
    • Export Citation
  • 9.

    Smith MR, Saad F, Chowdhury S, et al.. Apalutamide treatment and metastasis-free survival in prostate cancer. N Engl J Med 2018;378:1408–1418.

  • 10.

    Smith MR, Saad F, Chowdhury S, et al.. Apalutamide and overall survival in prostate cancer. Eur Urol 2020;79:150–158.

  • 11.

    Fizazi K, Shore N, Tammela TL, et al.. Darolutamide in nonmetastatic, castration-resistant prostate cancer. N Engl J Med 2019;380:1235–1246.

  • 12.

    Fizazi K, Shore N, Tammela TL, et al.. Nonmetastatic, castration-resistant prostate cancer and survival with darolutamide. N Engl J Med 2020;383:1040–1049.

  • 13.

    Hussain M, Fizazi K, Saad F, et al.. Enzalutamide in men with nonmetastatic, castration-resistant prostate cancer. N Engl J Med 2018;378:2465–2474.

  • 14.

    Sternberg CN, Fizazi K, Saad F, et al.. Enzalutamide and survival in nonmetastatic, castration-resistant prostate cancer. N Engl J Med 2020;382:2197–2206.

  • 15.

    Chi KN, Agarwal N, Bjartell A, et al.. Apalutamide for metastatic, castration-sensitive prostate cancer. N Engl J Med 2019;381:13–24.

  • 16.

    Davis ID, Martin AJ, Stockler MR, et al.. Enzalutamide with standard first-line therapy in metastatic prostate cancer. N Engl J Med 2019;381:121–131.

  • 17.

    Armstrong AJ, Szmulewitz RZ, Petrylak DP, et al.. ARCHES: a randomized, phase III study of androgen deprivation therapy with enzalutamide or placebo in men with metastatic hormone-sensitive prostate cancer. J Clin Oncol 2019;37:2974–2986.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 18.

    Abiraterone acetate [package insert]. Horsham, PA: Janssen Biotech, Inc.; 2020.

  • 19.

    Fizazi K, Tran N, Fein L, et al.. Abiraterone plus prednisone in metastatic, castration-sensitive prostate cancer. N Engl J Med 2017;377:352–360.

  • 20.

    James ND, de Bono JS, Spears MR, et al.. Abiraterone for prostate cancer not previously treated with hormone therapy. N Engl J Med 2017;377:338–351.

  • 21.

    de Wit R, de Bono J, Sternberg CN, et al.. Cabazitaxel versus abiraterone or enzalutamide in metastatic prostate cancer. N Engl J Med 2019;381:2506–2518.

  • 22.

    Fizazi K, Kramer G, Eymard JC, et al.. Quality of life in patients with metastatic prostate cancer following treatment with cabazitaxel versus abiraterone or enzalutamide (CARD): an analysis of a randomised, multicentre, open-label, phase 4 study. Lancet Oncol 2020;21:1513–1525.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 23.

    Noonan KL, North S, Bitting RL, et al.. Clinical activity of abiraterone acetate in patients with metastatic castration-resistant prostate cancer progressing after enzalutamide. Ann Oncol 2013;24:1802–1807.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 24.

    Loriot Y, Bianchini D, Ileana E, et al.. Antitumour activity of abiraterone acetate against metastatic castration-resistant prostate cancer progressing after docetaxel and enzalutamide (MDV3100). Ann Oncol 2013;24:1807–1812.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 25.

    Bianchini D, Lorente D, Rodriguez-Vida A, et al.. Antitumour activity of enzalutamide (MDV3100) in patients with metastatic castration-resistant prostate cancer (CRPC) pre-treated with docetaxel and abiraterone. Eur J Cancer 2014;50:78–84.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 26.

    Smith MR, Saad F, Rathkopf DE, et al.. Clinical outcomes from androgen signaling-directed therapy after treatment with abiraterone acetate and prednisone in patients with metastatic castration-resistant prostate cancer: post hoc analysis of COU-AA-302. Eur Urol 2017;72:10–13.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 27.

    Antonarakis ES, Lu C, Wang H, et al.. AR-V7 and resistance to enzalutamide and abiraterone in prostate cancer. N Engl J Med 2014;371:1028–1038.

  • 28.

    Antonarakis ES, Lu C, Luber B, et al.. Androgen receptor splice variant 7 and efficacy of taxane chemotherapy in patients with metastatic castration-resistant prostate cancer. JAMA Oncol 2015;1:582–591.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 29.

    Scher HI, Lu D, Schreiber NA, et al.. Association of AR-V7 on circulating tumor cells as a treatment-specific biomarker with outcomes and survival in castration-resistant prostate cancer. JAMA Oncol 2016;2:1441–1449.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 30.

    Scher HI, Graf RP, Schreiber NA, et al.. Assessment of the validity of nuclear-localized androgen receptor splice variant 7 in circulating tumor cells as a predictive biomarker for castration-resistant prostate cancer. JAMA Oncol 2018;4:1179–1186.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 31.

    Armstrong AJ, Halabi S, Luo J, et al.. Prospective multicenter validation of androgen receptor splice variant 7 and hormone therapy resistance in high-risk castration-resistant prostate cancer: the PROPHECY study. J Clin Oncol 2019;37:1120–1129.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 32.

    FDA Approves Merck’s KEYTRUDA® (pembrolizumab) for Adult and Pediatric Patients with Unresectable or Metastatic, Microsatellite Instability-High (MSI-H) or Mismatch Repair Deficient Cancer. Accessed December 29, 2020. Available at: https://www.merck.com/news/fda-approves-mercks-keytruda-pembrolizumab-for-adult-and-pediatric-patients-with-unresectable-or-metastatic-microsatellite-instability-high-msi-h-or-mismatch-repair-deficient-cance

    • PubMed
    • Export Citation
  • 33.

    Pembrolizumab [package insert]. Whitehouse Station, NJ: Merck & Co, Inc.; 2020.

  • 34.

    Graff JN, Alumkal JJ, Drake CG, et al.. Early evidence of anti-PD-1 activity in enzalutamide-resistant prostate cancer. Oncotarget 2016;7:52810–52817.

  • 35.

    Le DT, Durham JN, Smith KN, et al.. Mismatch repair deficiency predicts response of solid tumors to PD-1 blockade. Science 2017;357:409–413.

  • 36.

    Hansen AR, Massard C, Ott PA, et al.. Pembrolizumab for advanced prostate adenocarcinoma: findings of the KEYNOTE-028 study. Ann Oncol 2018;29:1807–1813.

  • 37.

    Abida W, Cheng ML, Armenia J, et al.. Analysis of the prevalence of microsatellite instability in prostate cancer and response to immune checkpoint blockade. JAMA Oncol 2019;5:471–478.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 38.

    Tucker MD, Zhu J, Marin D, et al.. Pembrolizumab in men with heavily treated metastatic castrate-resistant prostate cancer. Cancer Med 2019;8:4644–4655.

  • 39.

    Marabelle A, Le DT, Ascierto PA, et al.. Efficacy of pembrolizumab in patients with noncolorectal high microsatellite instability/mismatch repair-deficient cancer: results from the phase II KEYNOTE-158 study. J Clin Oncol 2020;38:1–10.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 40.

    Graham LS, Montgomery B, Cheng HH, et al.. Mismatch repair deficiency in metastatic prostate cancer: response to PD-1 blockade and standard therapies. PLoS One 2020;15:e0233260.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 41.

    Sena LA, Fountain J, Isaacsson Velho P, et al.. Tumor frameshift mutation proportion predicts response to immunotherapy in mismatch repair-deficient prostate cancer [published online November 20, 2020]. Oncologist, doi: 10.1002/onco.1360

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 42.

    Antonarakis ES, Piulats JM, Gross-Goupil M, et al.. Pembrolizumab for treatment-refractory metastatic castration-resistant prostate cancer: multicohort, open-label phase II KEYNOTE-199 study. J Clin Oncol 2020;38:395–405.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 43.

    Robinson D, Van Allen EM, Wu YM, et al.. Integrative clinical genomics of advanced prostate cancer. Cell 2015;161:1215–1228.

  • 44.

    Kaufman B, Shapira-Frommer R, Schmutzler RK, et al.. Olaparib monotherapy in patients with advanced cancer and a germline BRCA1/2 mutation. J Clin Oncol 2015;33:244–250.

  • 45.

    Mateo J, Carreira S, Sandhu S, et al.. DNA-repair defects and olaparib in metastatic prostate cancer. N Engl J Med 2015;373:1697–1708.

  • 46.

    Clarke N, Wiechno P, Alekseev B, et al.. Olaparib combined with abiraterone in patients with metastatic castration-resistant prostate cancer: a randomised, double-blind, placebo-controlled, phase 2 trial. Lancet Oncol 2018;19:975–986.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 47.

    Farmer H, McCabe N, Lord CJ, et al.. Targeting the DNA repair defect in BRCA mutant cells as a therapeutic strategy. Nature 2005;434:917–921.

  • 48.

    Olaparib [package insert]. Wilmington, DE: AstraZeneca Pharmaceuticals LP; 2020.

  • 49.

    Rucaparib [package insert]. Boulder, CO: Clovis Oncology, Inc.; 2020.

  • 50.

    Mateo J, Porta N, Bianchini D, et al.. Olaparib in patients with metastatic castration-resistant prostate cancer with DNA repair gene aberrations (TOPARP-B): a multicentre, open-label, randomised, phase 2 trial. Lancet Oncol 2020;21:162–174.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 51.

    de Bono J, Mateo J, Fizazi K, et al.. Olaparib for metastatic castration-resistant prostate cancer. N Engl J Med 2020;382:2091–2102.

  • 52.

    Hussain M, Mateo J, Fizazi K, et al.. Survival with olaparib in metastatic castration-resistant prostate cancer. N Engl J Med 2020;383:2345–2357.

  • 53.

    Abida W, Patnaik A, Campbell D, et al.. Rucaparib in men with metastatic castration-resistant prostate cancer harboring a BRCA1 or BRCA2 gene alteration. J Clin Oncol 2020;38:3763–3772.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 54.

    Abida W, Campbell D, Patnaik A, et al.. Non-BRCA DNA damage repair gene alterations and response to the PARP inhibitor rucaparib in metastatic castration-resistant prostate cancer: analysis from the phase II TRITON2 study. Clin Cancer Res 2020;26:2487–2496.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 55.

    Markowski MC, Antonarakis ES. BRCA1 versus BRCA2 and PARP inhibitor sensitivity in prostate cancer: more different than alike? J Clin Oncol 2020;38:3735–3739.

  • 56.

    Corn PG, Heath EI, Zurita A, et al.. Cabazitaxel plus carboplatin for the treatment of men with metastatic castration-resistant prostate cancers: a randomised, open-label, phase 1-2 trial. Lancet Oncol 2019;20:1432–1443.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 57.

    Romero-Laorden N, Lozano R, Jayaram A, et al.. Phase II pilot study of the prednisone to dexamethasone switch in metastatic castration-resistant prostate cancer (mCRPC) patients with limited progression on abiraterone plus prednisone (SWITCH study). Br J Cancer 2018;119:1052–1059.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 58.

    Attard G, Merseburger AS, Arlt W, et al.. Assessment of the safety of glucocorticoid regimens in combination with abiraterone acetate: a randomized, open-label phase 2 study. JAMA Oncol 2019;5:1159–1167.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 59.

    Fenioux C, Louvet C, Charton E, et al.. Switch from abiraterone plus prednisone to abiraterone plus dexamethasone at asymptomatic PSA progression in patients with metastatic castration-resistant prostate cancer. BJU Int 2019;123:300–306.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
Copyright:
Copyright © 2021 by the National Comprehensive Cancer Network 2021
Page Numbers:
10
Article Category:
Other
Print Publication Date:
01 Feb 2021
Online Publication Date:
02 Feb 2021

Metrics

All Time Past Year Past 30 Days
Abstract Views 0 0 0
Full Text Views 35947 4200 242
PDF Downloads 27635 2760 187
EPUB Downloads 0 0 0