Prostate cancer: guideline history

Anchored to: FDA approval of abiraterone for high-risk metastatic hormone-sensitive disease, February 2018 (LATITUDE, STAMPEDE)

• addedMetastatic hormone-sensitive, first line: Abiraterone plus prednisone with ADT as a category 1 option alongside docetaxel.

Anchored to: Annals of Oncology publication, 2020

• addedMetastatic hormone-sensitive, first line: ADT plus docetaxel, abiraterone, enzalutamide or apalutamide recommended over ADT alone [I, A].
• addedMetastatic castration-resistant, BRCA-mutant: Olaparib after an AR pathway inhibitor for BRCA1/2-mutated disease [I, A].

Anchored to: FDA approvals of 177Lu-PSMA-617 (March 2022, VISION) and darolutamide with docetaxel (August 2022, ARASENS)

• addedMetastatic castration-resistant, PSMA PET-positive, after ARPI and taxane: 177Lu-PSMA-617 as a category 1 option.
• addedMetastatic hormone-sensitive, first line: Triplet therapy: ADT plus docetaxel plus darolutamide (ARASENS) or abiraterone (PEACE-1) for high-volume disease.

Anchored to: FDA approvals of olaparib with abiraterone (May 2023, PROpel) and talazoparib with enzalutamide (June 2023, TALAPRO-2) for HRR-mutated castration-resistant disease

• addedMetastatic castration-resistant, BRCA/HRR-mutant, first line: PARP inhibitor plus AR pathway inhibitor combinations for BRCA-mutated (olaparib-abiraterone) or HRR-mutated (talazoparib-enzalutamide) disease.

Anchored to: FDA approval of 177Lu-PSMA-617 before taxane chemotherapy, March 2025 (PSMAfore)

• recategorisedMetastatic castration-resistant, PSMA PET-positive: 177Lu-PSMA-617 moves earlier: after one AR pathway inhibitor, before chemotherapy.after ARPI and taxane (VISION) → after ARPI, taxane-naive allowed (PSMAfore)