Treatment Types

Knowing when to use each treatment is critical for optimizing outcomes and individualizing care^1-3

RUBRACA^® (rucaparib) is a flexible, targeted, effective, and supportive PARPi that targets BRCA-mutated mCRPC and can be used after ANY ARPI and taxane-based chemotherapy.⁴*^† Learn more about RUBRACA at RubracaProstateHCP.com.

Patients should also receive a GnRH analog concurrently or should have had bilateral orchiectomy.⁴

^†

Demonstrated improvements in multiple efficacy outcomes: confirmed overall response rate (ORR) by independent radiology review (IRR), 46% (95% CI, 35%-57%); median duration of response (DOR) by IRR, 15.5 months (95% CI, 6.4-not reached).⁵

RUBRACA is indicated for patients previously treated with any androgen receptor-directed therapy and a taxane-based chemotherapy.⁴

Myelodysplastic syndrome (MDS)/acute myeloid leukemia (AML) occur in patients treated with RUBRACA, and are potentially fatal adverse reactions.

For Important Safety Information and full Prescribing Information for RUBRACA, visit RubracaProstateHCP.com.

ELIGARD^® (leuprolide acetate) is a GnRH agonist used as a foundation of treatment for advanced prostate cancer that provides proven efficacy and safety, customizable dosing, extended control, and unmatched access and support so you and your patients can feel empowered while on ADT.^6-12 
Learn more about ELIGARD at ELIGARDhcp.com.

ELIGARD for injectable suspension is a gonadotropin-releasing hormone (GnRH) agonist indicated for the treatment of advanced prostate cancer.⁶

ELIGARD may impair fertility in males of reproductive potential.

For Important Safety Information and full Prescribing Information for ELIGARD, visit ELIGARDhcp.com.

Different treatments can be used depending on the progression of aPC, and each class of therapy provides unique therapeutic benefits and risks for patients.

Select a treatment listed below to learn more about what it is and when it may be used.

Androgen receptor pathway inhibitors (ARPIs)¹³

ARPIs are a class of drugs that block the effect of androgens using direct or indirect modes of action.

Newer, next-generation therapies commonly used as add-on therapy for treating both metastatic and non-metastatic CSPC
Can be used before or after chemotherapy for mCRPC

Types of ARPIs and their indications:

Abiraterone indicated for mCSPC and mCRPC that works by suppressing CYP17A1-mediated androgen synthesis
Enzalutamide, apalutamide, and darolutamide all work by inhibiting androgen receptor transcription factor activity
- Enzalutamide is indicated for mCSPC and mCRPC
- Apalutamide is indicated for mCSPC and nmCRPC
- Darolutamide is indicated for nmCRPC and mCSPC

All ARPIs require concomitant ADT.

Immunotherapies¹⁴

Immunotherapies are advanced medicines that leverage the patient’s own immune system to combat cancer cells, and are a treatment option for those with mCRPC.

Sipuleucel-T is a dendritic cell vaccine that acts as an immunostimulant
Pembrolizumab is another immunotherapy that antagonizes the immune evasion capacity of tumors

Poly (ADP-ribose) polymerase inhibitors (PARPis)^4,5,15-18

PARPis are targeted medicines that block cancer cells from repairing their own DNA, causing apoptosis and cell death of the cancer cells

PARPis are used for patients with mCRPC who have specific gene mutations, such as BRCA1 or BRCA2, and work by inhibiting PARP-mediated repair of DNA strands, preventing the cancer cells from multiplying
Targeted PARPi treatments include rucaparib, olaparib, niraparib, and talazoparib

RUBRACA^® (rucaparib) is a flexible, targeted, effective, and supportive PARPi that targets BRCA-mutated mCRPC and can be used after ANY ARPI and taxane-based chemotherapy.*^†Learn more about RUBRACA at RubracaProstateHCP.com.

Patients should also receive a gonadotropin-releasing hormone (GnRH) analog concurrently or should have had bilateral orchiectomy.⁹

^†

RUBRACA is indicated for patients previously treated with any androgen receptor-directed therapy and a taxane-based chemotherapy.⁴

Myelodysplastic syndrome (MDS)/acute myeloid leukemia (AML) occur in patients treated with RUBRACA, and are potentially fatal adverse reactions.

For Important Safety Information and full Prescribing Information for RUBRACA, visit RubracaProstateHCP.com.

Chemotherapies¹³

Chemotherapies are drugs that directly kill or slow down the growth of cancer cells.

Docetaxel and cabazitaxel are chemotherapies commonly used as an add-on treatment in advanced prostate cancer
- Docetaxel is typically used for mCSPC and mCRPC
- Cabazitaxel is used in patients with mCRPC who have previously failed docetaxel

Radioligand therapy (RLT)¹³

Radioligand therapy is a category of targeted cancer treatment that uses radioactive isotopes (called radioligands) to precisely deliver radiation to cancer cells while minimizing off-target damage to healthy tissues for patients with mCRPC.

Radium 223 is used for patients with symptomatic bone metastasis
¹⁷⁷Lu-PSMA-617 or Lutetium-177 targets prostate cancer cells with PSMA-targeted radionuclide therapy

Orchiectomy¹⁹

Bilateral orchiectomy—or surgical removal of one or both testicles—once was used as the gold standard and is considered a type of hormone therapy.

Simple surgical procedure that is low cost and provides rapid and pronounced testosterone (T) control
Unfavorable aspects of this treatment can include:
- Irreversibility
- Negative psychological effects
- Broad spectrum of side effects
- Elevated FSH
- Contemporary lab testing indicates that testosterone levels decline to <20 ng/dL after orchiectomy

Androgen deprivation therapy (ADT)¹⁹

ADT is used as the foundation of therapy for advanced prostate cancer and can be given during the entirety of prostate cancer treatment. ADT, or hormone therapy, functions by reducing levels of male sex hormones, called androgens. Over time, other types of therapies can be added to a patient’s treatment plan in addition to ADT.

Luteinizing hormone-releasing hormone (LHRH) and gonadotropin-releasing hormone (GnRH) therapies

GnRH therapies were developed to help address side effects of added estrogens and bilateral orchiectomy
GnRH agonists and antagonists can be used to lower T in men with prostate cancer by interacting with GnRH receptors
GnRH agonists work by desensitizing GnRH receptors. The continuous stimulation causes initial increase in LH and T, with castration levels reached in 2-3 weeks. GnRH agonists are typically better tolerated over an extended period of time. GnRH agonists include:
- Leuprolide
- Goserelin
- Triptorelin
- Histrelin

GnRH antagonists block GnRH receptors and cause a decrease in LH and T, with castrate T levels reached in 2-3 days. GnRH antagonists include:
- Degarelix
- Relugolix

ELIGARD for injectable suspension is a gonadotropin-releasing hormone (GnRH) agonist indicated for the treatment of advanced prostate cancer.⁶

ELIGARD may impair fertility in males of reproductive potential.

For Important Safety Information and full Prescribing Information for ELIGARD, visit ELIGARDhcp.com.

More about the importance of T suppression

When using ADTs, assess T regularly to maintain T suppression ≤20 ng/dL². With ADTs, disease can continue to progress despite T suppression, so it’s important to identify CRPC early. ADTs can also cause many different side effects due to suppressing T, so combinatorial therapeutic strategies will need to be implemented and early mitigation of side effects should be completed to maintain the patient’s quality of life.²⁰

Other treatments like next-generation androgen receptor inhibitors (ARIs) and chemotherapies can be used as add-on treatments to ADT.

Nurse navigators are key mediators of shared decision-making between patients and their care teams and can help identify appropriate next steps in treatment planning—utilize nurse navigators for better treatment decision-making

Many treatments are
approved for advanced
prostate cancer (aPC)

Knowing when to use each treatment is critical for optimizing outcomes and individualizing care^1-3

Nurse navigators are key mediators of shared decision-making between patients and their care teams and can help identify appropriate next steps in treatment planning—utilize nurse navigators for better treatment decision-making

What would you do?

Biochemical recurrence after initial therapy

mCSPC

nmCRPC

mCRPC

Monitoring treatment response and recurrence

What can treatment look like for your patients?

Many treatments are approved for advanced prostate cancer (aPC)

Knowing when to use each treatment is critical for optimizing outcomes and individualizing care1-3

Nurse navigators are key mediators of shared decision-making between patients and their care teams and can help identify appropriate next steps in treatment planning—utilize nurse navigators for better treatment decision-making

What would you do?

Biochemical recurrence after initial therapy

mCSPC

nmCRPC

mCRPC

Monitoring treatment response and recurrence

What can treatment look like for your patients?

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Many treatments are
approved for advanced
prostate cancer (aPC)

Knowing when to use each treatment is critical for optimizing outcomes and individualizing care^1-3

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want to leave?