【AUA指南】去勢抵抗攝護腺癌(Castration-resistant prostate cancer)

Guideline statements

Index Patient 1

第一類病人

1. Clinicians should offer apalutamide or enzalutamide with continued androgen deprivation to patients with non-metastatic CRPC at high risk for developing metastatic disease. (Standard; Evidence Level Grade A)

1. 對於具有高危轉移傾向的非轉移性CRPC患者，推薦阿帕魯胺或恩雜魯胺以維持去勢治療（標準；證據水準 A）。

2. Clinicians may recommend observation with continued androgen deprivation to patients with non-metastatic CRPC at high risk for developing metastatic disease who do not want or cannot have one of the standard therapies. (Recommendation; Evidence Level Grade C)

2. 對於具有高危轉移傾向的非轉移性CRPC患者，在患者不願或不能接受標準治療的情況下，推薦採用觀察加持續性去勢療法（推薦；證據水準C）。

3. Clinicians may offer treatment with a second-generation androgen synthesis inhibitor (i.e. abiraterone plus prednisone) to select patients with non-metastatic CRPC at high risk for developing metastatic disease who do not want or cannot have one of the standard therapies and are unwilling to accept observation. (Option; Evidence Level Grade C)

3. 對於具有高危轉移傾向的非轉移性CRPC患者，在患者不願或不能接受標準去勢療法且不想接受觀察療法的情況下，可有選擇地推薦使用第二代合成雄激素阻斷劑（如阿比特龍加潑尼松）治療（可選；證據水準C）。

4. Clinicians should not offer systemic chemotherapy or immunotherapy to patients with non-metastatic CRPC outside the context of a clinical trial. (Recommendation; Evidence Level Grade C).

4. 對於非轉移性CRPC，除外臨床試驗，不推薦採用化療或免疫療法（推薦；證據水準C）。

Index Patient 2

第二類病人

5. Clinicians should offer abiraterone plus prednisone, enzalutamide, docetaxel, or sipuleucel-T to patients with asymptomatic or minimally symptomatic mCRPC with good performance status and no prior docetaxel chemotherapy. (Standard; Evidence Level Grade A [abiraterone plus prednisone and enzalutamide] /B [docetaxel and sipuleucel-T])

5. 對於無癥狀或癥狀輕微的mCRPC患者，在身體狀況良好且未接受過多西他賽化療的情況下，推薦使用阿比特龍加潑尼松、恩雜魯胺、多西他賽或sipuleucel-T治療 （標準; 證據水準 A [阿比特龍加潑尼松，恩雜魯胺] / B [多西他賽，sipuleucel-T]）。

6. Clinicians may offer first- generation anti-androgen therapy, ketoconazole plus steroid or observation to patients with asymptomatic or minimally symptomatic mCRPC with good performance status and no prior docetaxel chemotherapy who do not want or cannot have one of the standard therapies. (Option; Evidence Level Grade C)

6. 對於無癥狀或癥狀輕微的mCRPC患者，在身體狀況良好且未接受過多西他賽化療的情況下，當患者不願或不能接受標準的去勢治療時，推薦採用第一代抗雄激素療法，如酮康唑加類固醇激素或觀察療法。 （可選; 證據水準C）。

Index Patient 3

第三類病人

7. Clinicians should offer abiraterone plus prednisone, enzalutamide or docetaxel to patients with symptomatic, mCRPC with good performance status and no prior docetaxel chemotherapy. (Standard; Evidence Level Grade A [abiraterone plus prednisone and enzalutamide] / B [docetaxel])

7. 對於有轉移癥狀的mCRPC患者，在在身體狀況良好且未接受過多西他賽化療的情況下，推薦使用阿比特龍加潑尼松，恩雜魯胺或多西他賽治療（標準; 證據水準 A [阿比特龍加潑尼松，恩雜魯胺 / B [多西他賽]）。

8. Clinicians may offer ketoconazole plus steroid, mitoxantrone or radionuclide therapy to patients with symptomatic, mCRPC with good performance status and no prior docetaxel chemotherapy who do not want or cannot have one of the standard therapies. (Option; Evidence Level Grade C [ketoconazole and radionuclide therapy] / B [mitoxantrone])

8. 對於有轉移癥狀的mCRPC患者，在在身體狀況良好且未接受過多西他賽化療的情況下，在患者不願或不能接受標準去勢療法的情況下，推薦使用酮康唑加類固醇激素、米妥蒽醌或放射性核素治療（可選；證據水準 C [酮康唑，放射性核素] / B [米妥蒽醌]）。

9. Clinicians should offer radium-223 to patients with symptoms from bony metastases from mCRPC with good performance status and no prior docetaxel chemotherapy and without known visceral disease. (Standard; Evidence Level Grade B)

9. 對於合併骨轉移癥狀的mCRPC患者，在身體狀況良好、沒有已知的內臟轉移且沒有接受過多西他賽化療的情況下，推薦使用鐳-223治療（標準; 證據水準B）。

10. Clinicians should not offer treatment with either estramustine or sipuleucel-T to patients with symptomatic, mCRPC with good performance status and no prior docetaxel chemotherapy. (Recommendation; Evidence Level Grade C)

10. 對於有轉移癥狀的mCRPC患者，在身體狀況良好且沒有接受過多西他賽化療的情況下，不推薦使用雌二醇氮芥或sipuleucel-T治療（推薦；證據水準C）。

Index Patient 4

第四類病人

11. Clinicians may offer treatment with abiraterone plus prednisone or enzalutamide to patients with symptomatic, mCRPC with poor performance status and no prior docetaxel chemotherapy. (Option; Evidence Level Grade C)

11. 對於有轉移癥狀的mCRPC患者，在身體狀況不佳且沒有接受過多西他賽化療的情況下，推薦使用阿比特龍加潑尼松或恩雜魯胺治療（可選；證據水準C）。

12. Clinicians may offer treatment with ketoconazole plus steroid or radionuclide therapy to patients with symptomatic, mCRPC with poor performance status and no prior docetaxel chemotherapy who are unable or unwilling to receive abiraterone plus prednisone or enzalutamide. (Option; Evidence Level Grade C)

12. 對於有轉移癥狀的mCRPC患者，在全身狀況不佳且沒有接受過多西他賽化療的情況，當患者不能或不願接受阿比特龍加強的松或恩雜魯胺治療時，推薦使用酮康唑加類固醇激素或放射性核素治療（可選；證據水準 C）。

13. Clinicians may offer docetaxel or mitoxantrone chemotherapy to patients with symptomatic mCRPC with poor performance status and no prior docetaxel chemotherapy in select cases, specifically when the performance status is directly related to the cancer. (Expert Opinion)

13. 對於有轉移癥狀的mCRPC患者，在患者身體狀況不佳且沒有接受過多西他賽化療的情況下，針對某些特殊病例，尤其是當身體狀況不佳的原因與攝護腺癌直接相關時，可使用多西他賽或米妥蒽醌化療（專家意見）。

14. Clinicians may offer radium-223 to patients with symptoms from bony metastases from mCRPC with poor performance status and no prior docetaxel chemotherapy and without known visceral disease in select cases, specifically when the performance status is directly related to symptoms related to bone metastases. (Expert Opinion)

14. 對於有骨轉移癥狀的mCRPC患者，在患者身體狀況不佳但沒有已知的內臟病變且沒有接受過多西他賽化療的情況下，針對某些特殊病例，尤其是當身體狀況不佳的原因與攝護腺癌骨轉移直接相關時，可使用鐳-223治療（專家意見）。

15. Clinicians should not offer sipuleucel-T to patients with symptomatic, mCRPC with poor performance status and no prior docetaxel chemotherapy. (Recommendation; Evidence Level Grade C)

15. 對於有轉移癥狀且身體狀況不佳的mCRPC患者，在沒有接受過多西他賽化療的情況下，不推薦採用sipuleucel-T免疫療法（推薦；證據水準C）。

Index Patient 5

第五類病人

16. Clinicians should offer treatment with abiraterone plus prednisone, cabazitaxel or enzalutamide to patients with mCRPC with good performance status who received prior docetaxel chemotherapy. If the patient received abiraterone plus prednisone prior to docetaxel chemotherapy, they should be offered cabazitaxel or enzalutamide. (Standard; Evidence Level Grade A [abiraterone plus prednisone and enzalutamide] / B [cabazitaxel])

16. 對於接受過多西他賽化療的mCRPC患者，在身體狀況良好的情況下，推薦使用阿比特龍加潑尼松、卡巴他賽或恩雜魯胺治療。如果在接受多西他賽化療前使用過阿比特龍加潑尼松，推薦使用卡巴他賽或恩雜魯胺（標準；證據水準A[阿比特龍加潑尼松，恩雜魯胺] / B[卡巴他賽]）。

17. Clinicians may offer ketoconazole plus steroid to patients with mCRPC with good performance status who received prior docetaxel if abiraterone plus prednisone, cabazitaxel or enzalutamide is unavailable. (Option; Evidence Level Grade C)

17. 對於接受過多西他賽化療的mCRPC患者，在身體狀況良好的情況下，如果不能提供阿比特龍加類固醇激素、卡巴他賽或恩雜魯胺治療，推薦使用酮康唑加類固醇激素激素治療（可選；證據水準C）。

18. Clinicians may offer retreatment with docetaxel to patients with mCRPC with good performance status who were benefitting at the time of discontinuation (due to reversible side effects) of docetaxel chemotherapy. (Option; Evidence Level Grade C)

18. 對於曾經從多西他賽化療中獲益，但是由於可逆性副作用而中斷過治療的mCRPC患者，在身體狀況良好的情況，推薦重複應用多西他賽化療（可選；證據水準C）。

19. Clinicians should offer radium-223 to patients with symptoms from bony metastases from mCRPC with good performance status who received prior docetaxel chemotherapy and without known visceral disease. (Standard; Evidence Level Grade B)

19. 對於曾接受過多西他賽化療的有骨轉移癥狀的mCRPC患者，在身體狀況良好且沒有已知的內臟病變的情況下，推薦使用鐳-223治療（標準；證據水準B）。

Index Patient 6

第六類病人

20. Clinicians should offer palliative care to patients with mCRPC with poor performance status who received prior docetaxel chemotherapy. Alternatively, for selected patients, clinicians may offer treatment with abiraterone plus prednisone, enzalutamide, ketoconazole plus steroid or radionuclide therapy. (Expert Opinion)

20. 對於曾經接受過多西他賽化療且身體狀況不良的mCRPC患者，推薦姑息療法。針對某些特殊病例，可有選擇地使用阿比特龍加潑尼松、恩雜魯胺、酮康唑加類固醇激素或放射性核素治療（專家意見）。

21. Clinicians should not offer systemic chemotherapy or immunotherapy to patients with mCRPC with poor performance status who received prior docetaxel chemotherapy. (Expert Opinion)

21. 對於曾接受過多西他賽化療且身體狀況不佳的mCRPC患者，不推薦採用系統性化療或免疫治療（專家意見）。

Bone Health

骨健康

22. Clinicians should offer preventative treatment (e.g., supplemental calcium, vitamin D) for fractures and skeletal related events to CRPC patients. (Recommendation; Evidence Level Grade C)

22. 對於合併骨折或其它骨相關事件的CRPC患者，推薦預防性補充鈣劑及維生素D（推薦；證據水準C）。

23. Clinicians may choose either denosumab or zoledronic acid when selecting a preventative treatment for skeletal related events for mCRPC patients with bony metastases. (Option; Evidence Level Grade C)

23. 對於有骨轉移的mCRPC患者，為預防骨相關事件的發生，可選擇使用地諾單抗或唑來膦酸治療（可選；證據水準C）。

• PDF指南全文獲取方式
  

方式一：

後台回復「20190512」獲取下載鏈接