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Non-metastatic castration-resistant prostate cancer is a PSA that keeps rising on hormone therapy while scans still show nothing. Three androgen receptor blockers, apalutamide, enzalutamide and darolutamide, each delay metastasis by about two years and lengthen life, and darolutamide is the gentlest.
Non-metastatic castration-resistant prostate cancer is defined by a rising PSA with castrate testosterone (below 50 ng/dL) and no metastases on CT and bone scan. It is found in men on long-term androgen deprivation, and the risk is judged by PSA doubling time: under ten months marks high risk. Three trials in men with a doubling time of ten months or less changed care in 2018 and 2019: SPARTAN (apalutamide), PROSPER (enzalutamide) and ARAMIS (darolutamide) each roughly doubled metastasis-free survival, from about 16 to 18 months to 36 to 40 months, and each later showed longer overall survival, so all three are approved. Darolutamide crosses into the brain least and causes the fewest falls, fractures and cognitive effects. Men with a slow doubling time can be observed on hormone therapy. PSMA PET now finds metastases in most of these men, which moves them into metastatic castration-resistant disease on paper without changing their biology, so guidelines still treat by the conventional imaging that the trials used.
Averages across everyone diagnosed, often years ago. A median is the middle of a group: half the people counted lived longer than the figure shown, and some lived far longer. Your stage, subtype, age, fitness and the treatment you receive matter more than the average, and the numbers are improving quickly.
A shrinking group, because PSMA PET reveals metastases in most men once called non-metastatic; about a third with a PSA doubling time under ten months developed visible metastases within two years on hormone therapy alone.
About three quarters of cancers arise in the peripheral zone at the back of the gland, the part a finger or a biopsy needle reaches; drainage is to the obturator and iliac nodes.
Same organ: Prostate cancer, Ductal adenocarcinoma of the prostate, Localised prostate cancer, very low and low risk, Localised prostate cancer, intermediate risk, Localised prostate cancer, high and very high risk, Biochemical recurrence of prostate cancer, Metastatic hormone-sensitive prostate cancer, Metastatic castration-resistant prostate cancer, Neuroendocrine and small-cell prostate cancer
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Also on OnCo: Symptoms and red flags · Early detection roadmap.
Continue androgen deprivation and add apalutamide (SPARTAN), enzalutamide (PROSPER) or darolutamide (ARAMIS); darolutamide preferred when falls or cognition are concerns.
Observation on androgen deprivation with PSA monitoring and imaging; first-generation antiandrogen or its withdrawal as older options.
PSMA PET locates disease in most men; conventional imaging still defines the setting the trials studied.
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Darolutamide is often preferred in older men or those with fall or cognitive concerns because of its favourable tolerability among the three approved agents.
Enzalutamide is one of three androgen receptor inhibitors standard for high-risk non-metastatic castration-resistant prostate cancer.
Apalutamide, enzalutamide or darolutamide are standard for high-risk non-metastatic castration-resistant prostate cancer, a setting largely defined by conventional imaging.
Query for this cancer: (TITLE:"Non-metastatic castration-resistant prostate cancer" OR ABSTRACT:"Non-metastatic castration-resistant prostate cancer" OR TITLE:"nmCRPC" OR ABSTRACT:"nmCRPC" OR TITLE:"M0 CRPC" OR ABSTRACT:"M0 CRPC" OR TITLE:"Non-metastatic CRPC" OR ABSTRACT:"Non-metastatic CRPC" OR TITLE:"Rising PSA on hormone therapy without metastases" OR ABSTRACT:"Rising PSA on hormone therapy without metastases" OR TITLE:"Non-metastatic hormone-relapsed prostate cancer" OR ABSTRACT:"Non-metastatic hormone-relapsed prostate cancer") AND (treatment OR therapy OR trial OR survival OR diagnosis). Results are unfiltered search hits about Non-metastatic castration-resistant prostate cancer, not a curated reading list.
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A swollen painful calf, or sudden breathlessness with chest pain; the tamoxifen boxed warning covers pulmonary embolism and stroke.
Hormone therapy thins bone from the first year of treatment: in a study of 50,613 men, 19.4 percent of those on androgen deprivation who survived at least five years had a fracture, against 12.6 percent of those not on it. A bone weakened by cancer or by treatment can break with very little force, so sudden severe pain with an inability to bear weight is an emergency assessment.
Prostate Cancer UK says evidence suggests hormone therapy might increase the chance of developing heart disease, stroke and type-2 diabetes; in 73,196 men, GnRH agonist use carried an adjusted hazard ratio of 1.16 for coronary heart disease and 1.16 for sudden cardiac death. Chest pain or stroke symptoms are 999 whatever the cause.
NICE NG234 says to immediately contact the metastatic spinal cord compression coordinator if a person with a past or current diagnosis of cancer presents with bladder or bowel dysfunction, gait disturbance or difficulty walking, limb weakness, neurological signs of spinal cord or cauda equina compression, numbness, paraesthesia or sensory loss, or radicular pain, and to treat this as an oncological emergency.
CYP3A4: Apalutamide (strong inducer) lowers Darolutamide exposure and may cause loss of efficacy.. Avoid combined P-gp and strong CYP3A4 inducers.
CYP3A4: Enzalutamide (strong inducer) lowers Darolutamide exposure and may cause loss of efficacy.. Avoid combined P-gp and strong CYP3A4 inducers.
See all on the product pages:ApalutamideBicalutamideBone metastases and skeletal-related eventsCancer-related fatigue (tiredness)DarolutamideDenosumabEnzalutamideZoledronic acid·Printable cards in the navigator
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