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5 treatment settings, 5 with more than one named option. Each section lays out the options the standard of care names, what each is for, the trials behind them with their recorded results, the side effects and cautions on record, and questions to ask. Built from the cancer page's standard-of-care rows; nothing here is advice for your case.
Abiraterone or enzalutamide; add olaparib, talazoparib or niraparib for HRR-mutant, above all BRCA-mutant, disease (PROpel, TALAPRO-2, MAGNITUDE).
Abiraterone is a pill that shuts down testosterone production everywhere, including inside the tumour. Discovered at the Institute of Cancer Research, now generic and used from the first metastatic diagnosis.
Enzalutamide is a second-generation androgen-receptor blocker that stops the receptor binding testosterone, entering the nucleus and switching on genes. It is approved at every stage of advanced prostate cancer, from rising PSA after surgery to castration-resistant disease, and fatigue, falls and memory problems are its main drawbacks.
Olaparib was the first PARP inhibitor, and turned an inherited BRCA mutation from a risk factor into a drug target, including after surgery in breast cancer.
Talazoparib is a PARP inhibitor that traps PARP on DNA about 100 times more strongly than olaparib, which is why it works at a 1 mg daily dose. It is approved for germline BRCA-mutant HER2-negative breast cancer and, with enzalutamide, for HRR-mutant castration-resistant prostate cancer; anaemia is its dominant side effect.
Niraparib is a PARP inhibitor approved as maintenance for ovarian cancer regardless of BRCA status, and in prostate cancer with abiraterone.
rPFS HR 0.66 (ITT); OS HR 0.81 (NS).
rPFS HR 0.63 (ITT); OS HR 0.80 (ITT), 0.62 (HRR-mutant).
BRCA cohort rPFS HR 0.53; HRR-negative futility.
| Side effect | Any grade | Grade 3+ |
|---|---|---|
| Anaemia · OlympiA adjuvant, n=911 | 24% | 9% |
| Neutropenia · OlympiA adjuvant, n=911 | 16% | 5% |
| Leukopenia · OlympiA adjuvant, n=911 | 17% | 3% |
| Fatigue · OlympiA adjuvant, n=911 | 42% | 1.8% |
Rates from the label or pivotal trial as recorded on the product page; each grade 3+ figure links to its source.
| Side effect | Any grade | Grade 3+ |
|---|---|---|
| Thrombocytopenia · PRIMA | 66% | 38% |
| Anaemia · PRIMA | 65% | 31% |
| Neutropenia · PRIMA | - | 17% |
| Nausea · PRIMA | 62% | - |
Rates from the label or pivotal trial as recorded on the product page; each grade 3+ figure links to its source.
Add these to your appointment list, or take the full question set for this cancer.
Docetaxel; olaparib or rucaparib for BRCA-mutant disease (PROfound); 177Lu-PSMA-617 for PSMA-positive disease before chemotherapy (PSMAfore); pembrolizumab for mismatch repair-deficient tumours.
The first chemotherapy to extend life in prostate cancer (2004), now part of triplet therapy at first metastatic diagnosis.
Olaparib was the first PARP inhibitor, and turned an inherited BRCA mutation from a risk factor into a drug target, including after surgery in breast cancer.
A PARP inhibitor for BRCA-mutated ovarian and prostate cancer whose original maker went bankrupt; still available, with a narrowed label.
A radioactive drug that seeks out PSMA on prostate cancer cells; the best-selling radiopharmaceutical ever.
Pembrolizumab is a PD-1 blocking antibody approved in more than 40 settings, from melanoma and lung cancer to the first tumour-agnostic approval for mismatch-repair-deficient tumours in 2017, and before and after surgery in triple-negative breast cancer. A subcutaneous form arrived in 2025, and it is the backbone partner for ADCs and personalised neoantigen vaccines.
rPFS HR 0.34; OS HR 0.69 (cohort A).
rPFS HR 0.41.
| Side effect | Any grade | Grade 3+ |
|---|---|---|
| Anaemia · OlympiA adjuvant, n=911 | 24% | 9% |
| Neutropenia · OlympiA adjuvant, n=911 | 16% | 5% |
| Leukopenia · OlympiA adjuvant, n=911 | 17% | 3% |
| Fatigue · OlympiA adjuvant, n=911 | 42% | 1.8% |
Rates from the label or pivotal trial as recorded on the product page; each grade 3+ figure links to its source.
| Side effect | Any grade | Grade 3+ |
|---|---|---|
| Lymphocytes decreased · VISION | 85% | 47% |
| Haemoglobin decreased · VISION | 64% | 15% |
| Platelets decreased · VISION | - | 9% |
| Fatigue · VISION | 48% | - |
Rates from the label or pivotal trial as recorded on the product page; each grade 3+ figure links to its source.
| Side effect | Any grade | Grade 3+ |
|---|---|---|
| Hypothyroidism (immune-mediated) · Pooled monotherapy data, >2,800 patients | 8% | - |
| Pneumonitis (immune-mediated) · Pooled monotherapy data, >2,800 patients | 3.4% | - |
| Colitis (immune-mediated) · Pooled monotherapy data, >2,800 patients | 1.7% | - |
| Hepatitis (immune-mediated) · Pooled monotherapy data, >2,800 patients | 0.7% | - |
Rates from the label or pivotal trial as recorded on the product page; each grade 3+ figure links to its source.
Add these to your appointment list, or take the full question set for this cancer.
177Lu-PSMA-617 (VISION), cabazitaxel, radium-223 for symptomatic bone-only disease (ALSYMPCA), or a PARP inhibitor if not yet used.
A radioactive drug that seeks out PSMA on prostate cancer cells; the best-selling radiopharmaceutical ever.
A second taxane that works after docetaxel and beat a second hormone pill head-to-head (CARD).
Radium-223 was the first alpha-emitting drug ever approved (2013). It homes to bone like calcium and treats prostate cancer that has spread only to bone.
OS HR 0.62.
OS HR 0.70.
PSA50 66% vs 37%; OS HR 0.97.
| Side effect | Any grade | Grade 3+ |
|---|---|---|
| Lymphocytes decreased · VISION | 85% | 47% |
| Haemoglobin decreased · VISION | 64% | 15% |
| Platelets decreased · VISION | - | 9% |
| Fatigue · VISION | 48% | - |
Rates from the label or pivotal trial as recorded on the product page; each grade 3+ figure links to its source.
Add these to your appointment list, or take the full question set for this cancer.
Denosumab or zoledronic acid to prevent skeletal events, with calcium and vitamin D; palliative radiotherapy to painful metastases.
Denosumab is an injection under the skin that blocks the signal driving bone breakdown. As Xgeva it prevents fractures and other bone complications in people whose cancer has spread to bone or who have myeloma; as Prolia it treats osteoporosis, including bone loss caused by hormone therapy for breast and prostate cancer.
Zoledronic acid (Zometa) is a fifteen-minute infusion given every few weeks or months to strengthen bone and prevent fractures, spinal cord compression and the need for radiotherapy in people with myeloma or cancer that has spread to bone; it also treats dangerously high calcium caused by cancer.
Stereotactic body radiotherapy converges multiple beams with sub-millimetre accuracy to deliver tumour-destroying doses in one to five outpatient sessions, doing the job of surgery for inoperable early lung cancer and for metastases in liver, spine and brain. Tumour size and location limit its use, and late toxicity is a concern near the central airways.
No trial record is attached to this row yet. The trials tab lists what is recruiting and the landmark trials for this cancer.
Add these to your appointment list, or take the full question set for this cancer.
Actinium-225 PSMA radioligands, the STEAP1 T-cell engager xaluritamig, the EZH2 inhibitor mevrometostat and 177Lu-PSMA-I&T within trials.
Alpha-emitting PSMA drugs that produce responses even after Pluvicto fails, held back mainly by isotope supply.
Xaluritamig is Amgen's T-cell engager for prostate cancer, now in two phase 3 trials, aiming to do for prostate cancer what tarlatamab did for small-cell lung cancer.
An epigenetic drug that may re-sensitise prostate cancer to hormone therapy, in three phase 3 trials with enzalutamide.
177Lu-PSMA-I&T is a second PSMA radioligand, chemically different from Pluvicto, that has passed two phase 3 trials on progression but has not yet shown a survival benefit.
No headline result recorded yet.
No headline result recorded yet.
No headline result recorded yet.
rPFS HR 0.71; interim OS HR 1.11.
rPFS significantly improved.
No side-effect rates or interaction flags are recorded for these options yet. The side-effect lookup and interaction checker cover the products that have them.
Add these to your appointment list, or take the full question set for this cancer.