Page 3 - Uro_Onco_booklet

Part 1: Management of Men with Castration-Naïve mPC

No. Statements
To confirm mPC, imaging tools, in addition to clinical
1
examination, should be employed.
The definition of high-volume disease in castration-
naïve mPC remains uncertain, but the general principle
2 of ≥ 4 sites of bone metastases (with at least one bone
metastasis beyond the pelvis and axial skeleton), or any
visceral metastases, is being accepted.
Regarding a basic work-up investigation, whole-body
MRI or dual-tracer PET/CT scan is preferred if resources
3 or facilities are available. Otherwise, CT scan (from
thoraces to pelvis) plus bone scan is an acceptable
option. Ultrasound alone is not recommended.
ADT is the standard of care. Supplemental calcium/
4 vitamin D3 is recommended following ADT, in view of
the risk of osteoporosis associated with ADT.
Chemotherapy (six cycles of docetaxel) should be
considered in addition to ADT for all M1 patients who
are fit enough for chemotherapy. The following factors
5
should be taken into account:
a. Volume of castration-naïve mPC (i.e. high vs low)
b. Performance status
Chemotherapy with docetaxel should NOT be given to
6
patients with M0 disease.
Anti-androgen monotherapy or oestrogen is NOT
7
recommended as first-line treatment.

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