The American Society of Clinical Oncology (ASCO) offered a provisional clinical opinion (PCO) regarding second-line hormonal therapy for men with non-metastatic or minimally symptomatic metastatic castration-resistant prostate cancer (CRPC). The PRO was published in the Journal of Clinical Oncology.1

ASCO recommends that men with CRPC maintain castrate-levels of testosterone. There are, however, no data to support the use of second-line hormonal therapy among men with non-metastatic CRPC, though agents such as anti-androgens and CYP17 inhibitors can be considered for patients at a high risk of metastasis.

Abiraterone or enzalutamide are recommended as second-line hormonal therapies for men with CRPC with radiographic evidence of metastases.

Continue Reading

The PCO does not provide guidance on the preference or sequencing of these agents due to a paucity of data. ASCO suggests sipuleucel-T, docetaxel plus prednisone, or radium-223 as alternative options.

The PCO recommends that clinicians assess PSA levels every 3 months for men with a rapid PSA doubling time, velocity, or with documented metastases. Recommended imaging modalities include a bone scan with CT or MRI of the abdomen and pelvis.

ASCO recommends against routine radiographic imaging unless the results would alter treatment decisions, or if prostate cancer-specific symptoms develop or worsen.

RELATED: PSA Density More Accurate Than PSA for Predicting Prostate Cancer

This PCO considers data from 6 phase 3 randomized controlled trials and expert consensus opinion. It will be updated as results from ongoing trials are published.


  1. Virgo KS, Basch E, Loblaw DA, et al. Second-line hormonal therapy for men with chemotherapy-naïve, castration-resistant prostate cancer: American Society of Clinical Oncology provisional clinical opinion. J Clin Oncol. 2017 Apr 25. doi: 10.1200/JCO.72.8030 [Epub ahead of print]