Prostate cancer
Malignant epithelial tumor of the prostate. NCCN/EAU risk stratification uses PSA, Gleason score, and TNM stage. Localized disease: active surveillance at low risk; radical prostatectomy or radiotherapy at intermediate and high risk. Metastatic or hormone-sensitive disease: androgen-deprivation therapy (GnRH agonists, antagonist degarelix) ± antiandrogens (bicalutamide, cyproterone acetate) or next-generation androgen-axis inhibitors (abiraterone, enzalutamide).
ICD-10 C613 drugs
Also known as: Prostate adenocarcinoma
Drugs used for this condition
- AAbirateroneFirst line · Androgen biosynthesis inhibitorsMetastatic castration-resistant prostate cancer (mCRPC) and metastatic hormone-sensitive (mHSPC) per ESMO 2020 and Spanish SEOM 2021 guidelines. In mHSPC used as first-line with androgen deprivation (LATITUDE, Lancet Oncol 2019 showed a 16.8-month median overall survival increase (53.3 vs 36.5 months)). Dose 1000 mg (4×250 mg tablets) once daily on empty stomach + prednisolone 5 mg 1–2 times daily. Alternative – enzalutamide or apalutamide (docetaxel for visceral metastases).
- BBicalutamideSecond line · Non-steroidal antiandrogenFoundation therapy in metastatic hormone-sensitive prostate cancer within maximum androgen blockade with GnRH agonists (leuprolide, goserelin) per EAU 2024. Dose 50 mg once daily. In the first 1–2 weeks after GnRH agonist start, used to prevent the testosterone flare. Monotherapy at 150 mg daily is possible in localized cancer without metastases as an alternative to androgen-deprivation therapy – with better quality of life but lower survival.
- BCyproterone acetateSecond line · Antiandrogen with progestogenic activityIn metastatic hormone-sensitive prostate cancer, used as monotherapy or with a GnRH agonist to prevent the testosterone flare. Dose 100–300 mg/day. EAU 2024 sets androgen-deprivation therapy (GnRH agonists or antagonists) ± abiraterone, enzalutamide, or docetaxel as first-line; cyproterone acetate is an alternative when access to newer agents is limited.
How to read tiers A–F
Evidence tiers belong to the drug-indication pair, not to the drug as a whole: the same substance can be A for one condition and F for another.
- AStrong evidence – first or second line in international guidelines
- BRecommended in selected cases
- CStudy data contradict each other
- DBenefit not proven, no documented harm
- FDocumented harm, or risk without benefit