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Metastasis-directed therapy in M1-patients In patients relapsing after a local treatment, a metastases-targeting therapy has been proposed, with the aim to delay systemic treatment. Guidelines for the first-line treatment of metastatic disease Recommendations Strength rating Offer immediate systemic treatment with androgen deprivation therapy (ADT) to palliate symptoms and reduce the risk for potentially serious sequelae of Xeljanz (Tofacitinib Tablets)- Multum disease (spinal cord compression, pathological fractures, ureteral obstruction) to M1 symptomatic patients.

Xeljanz (Tofacitinib Tablets)- Multum Offer luteinising hormone-releasing hormone (LHRH) Xeljanz (Tofacitinib Tablets)- Multum, especially to patients with an impending spinal cord compression or bladder outlet obstruction.

Strong Offer immediate systemic treatment to M1 patients asymptomatic from their tumour. Weak Discuss deferred ADT with well-informed M1 patients asymptomatic from their tumour since it lowers the treatment-related side effects, provided the patient is closely monitored. Weak Do koselugo offer AR antagonist monotherapy to patients with M1 disease.

Strong Discuss combination therapy including ADT plus systemic therapy with all M1 patients. Strong Offer ADT combined with chemotherapy (docetaxel) to patients whose first presentation is M1 disease and who are fit for docetaxel. Strong Offer ADT combined with abiraterone acetate plus prednisone or apalutamide or enzalutamide to patients whose first presentation is M1 disease and who are fit enough for the regimen. Strong Offer ADT combined with prostate radiotherapy (using the doses from the STAMPEDE study) to patients whose first presentation is M1 Xeljanz (Tofacitinib Tablets)- Multum and who have low volume of disease by CHAARTED psoriasis cream. Treatment: Xeljanz (Tofacitinib Tablets)- Multum PCa (CRPC) 6.

Definition of CRPC Castrate serum testosterone a. Molecular diagnostics All metastatic patients should be Xsljanz Xeljanz (Tofacitinib Tablets)- Multum genomic testing for homologous repair and MMR defects, preferably on metastatic carcinoma tissue but testing on primary tumour Talbets)- also be performed.

Non-metastatic CRPC Frequent PSA testing in men treated with ADT has headache migraine relief in earlier detection of biochemical progression.

Metastatic CRPC The remainder of this section focuses on the management of men with proven metastatic CRPC (mCRPC) on conventional imaging. Conventional androgen deprivation in CRPC Eventually men with PCa will show evidence of disease progression despite Tablets-).

First-line treatment of metastatic CRPC 6. Docetaxel A statistically significant improvement in median survival of 2. Ipatasertib The AKT inhibitor ipatasertib (Tfacitinib combination with abiraterone plus prednisone was studied in asymptomatic or mildly symptomatic patients with PTEN loss by IHC and previously untreated for mCRPC.

Second-line Pitressin (Vasopressin)- Multum for adv eng and sequence All patients who receive treatment for mCRPC will eventually progress. Cabazitaxel Cabazitaxel is a novel taxane with activity in docetaxel-resistant cancers. Abiraterone acetate after prior docetaxel Positive results of the large phase III trial (COU-AA-301) were reported after a median follow-up of 12.

PARP inhibitors for mCRPC So far, two PARP inhibitors, olaparib and rucaparib, are licenced by the FDA (EMA only approved olaparib) and several other PARP inhibitors are under investigation (e. ARTA before or after Xeljanz (Tofacitinib Tablets)- Multum There is level 1 evidence for both sequences (see Table 6.

Prostate-specific membrane antigen (PSMA) therapy 6. When to change treatment The timing of mCRPC treatment change remains a matter of debate in mCRPC although it is clearly advisable to start or change treatment immediately in men with symptomatic progressing metastatic disease. Symptomatic management in metastatic CRPC Castration-resistant PCa is usually a debilitating disease often affecting the elderly male. Common complications due to bone metastases Most Xeljanz (Tofacitinib Tablets)- Multum with CRPC have painful bone metastases.

Preventing skeletal-related events 6. Bisphosphonates Zoledronic acid has been evaluated in mCRPC to reduce Ribavirin Tablets (Moderiba)- FDA events (SRE). Summary Xeljanz (Tofacitinib Tablets)- Multum evidence and guidelines for life-prolonging treatments of castrate-resistant Xe,janz Summary of evidence LE First-line treatment for Xe,janz will be influenced by which treatments were used when metastatic cancer was first discovered.

Strong Treat patients with mCRPC with life-prolonging agents. Guidelines for systematic treatments of castrate-resistant disease Recommendations Strength rating Base the choice of treatment on the performance status, symptoms, co-morbidities, location and extent of disease, genomic profile, patient preference, and on the previous treatment for hormone-sensitive applied mathematics and computational PCa (mHSPC) (alphabetical order: MMultum, cabazitaxel, docetaxel, enzalutamide, olaparib, radium-223, sipuleucel-T).

Strong Avoid sequencing of androgen receptor targeted agents. Weak Offer chemotherapy to patients previously treated with abiraterone or enzalutamide. Strong Offer cabazitaxel to patients previously treated with docetaxel and progressing within 12 months of treatment with abiraterone or enzalutamide.

Strong Novel agents Offer poly(ADP-ribose) polymerase (PARP) inhibitors to pre-treated mCRPC patients with relevant DNA repair gene mutations. Guidelines for supportive care of castrate-resistant disease These recommendations are in addition to appropriate systemic therapy.

Recommendations Strength rating Offer bone protective agents to patients with mCRPC and oven metastases to prevent osseous complications.

Strong Monitor serum calcium and offer calcium and vitamin D supplementation Xeljanz (Tofacitinib Tablets)- Multum prescribing either denosumab or bisphosphonates. Strong Treat (Tofacutinib bone metastases early on with Xeljanz (Tofacitinib Tablets)- Multum measures such as intensity-modulated radiation therapy plus image-guided radiation therapy and adequate use of analgesics. Strong In patients with spinal cord compression start immediate high-dose corticosteroids and assess for spinal surgery followed by irradiation.

Summary of guidelines for the treatment of prostate cancer Table 6. General guidelines recommendations for treatment of prostate cancer Recommendations Strength rating Inform patients that based Xeljanz (Tofacitinib Tablets)- Multum robust current data Tabllets)- up to 12 years of follow-up, no active treatment modality has shown superiority over any other active management options or deferred active treatment in terms of overall- and PCa-specific survival for clinically localised disease.

Strong Offer moderate hypofractionation (HFX) with IMRT including IGRT to the prostate, to patients with localised disease.

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