Metastatic Prostate Cancer Medications
Page updated Winter 2021.
Disclaimer: Medicine is an ever-changing science. We have been witnessing changes in diagnostic and therapeutic modalities and guidelines during last several years. We have used sources believe to be reliable for purpose of this website including AUA guidelines, EAU guidelines, NCCN guidelines, Campbell-Walsh-Wein Urology, UpToDate, Merck Manual, Lexi-Comp, FDA website, and other reputable sources. However, due to possibility of human error or changes in medicine, readers are required to confirm the information provided in this website with other sources. Readers are specially required to read all parts of the product information sheet included in the package of each drug they plan to administer and follow those instructions. Readers are also needed to follow instructions of FDA and other regulatory bodies and their own department in this regard. Authors can cite information provided in our textbooks or they need to cite the original sources. This website serves as a general framework. We and other users would adjust the approach per departments policies and patients situation. Forms can be used by other health care professionals.
LHRH Agonists
Leuprolide (Lupron)
7.5 mg IM for 1-Month
22.5 mg IM for 3-Months
30 mg IM for 4-Months
45 mg IM for 6-Months
Leuprolide (Eligard)
Same dose as above, SC
Goserelin (Zoladex)
3.6 mg SC- for 1-Month
10.8 mg SC- for 3-Months
Triptorelin (Trelstar)
3.75 mg IM for 1 Month
11.25 mg IM for 3 Months
22.5 mg IM for 6 Months
LHRH Antagonists
Degarelix (Firmagon)
Initial dose: 240 SC in 2 divided dose
Then : 80 mg SC every 28 days
Abarelix (Plenaxis)
100 mg administered intramuscularly to the buttock on day 1, 15, 29 (week 4) and every 4 weeks thereafter.
Non-steroidal Anti-androgens
Bicalutamide (Casodex)
50 mg PO daily for 4 weeks to block LHRH agonists flare-up phenomenon.
Flutamide (Eulexin)
250 mg PO q8hr for 4 weeks to block LHRH agonists flare-up phenomenon.
Nilutamide (Nilandron)
300 mg PO daily for 4 wks to block LHRH agonists flare-up phenomenon.
Androgen Synthesis Inhibitors
Abirateron (Zytiga)
1000 mg PO daily
Add Prednisone 5 mg PO q12hr
Second-Generation Androgen Receptor Antagonists
Enzalutamide (Xtandi)
160 mg PO, daily
Apalutamide (Erleada)
240 mg PO, daily
Chemotherapy Agents
Docetaxel (Taxotere)
75 mg/m2 IV over 1 hr q3 Weeks
Add Prednisone 5 mg PO q12hr
Cabazitaxel (Jevtana)
20 mg/m2 IV over 1 hr q3 Weeks
Add Prednisone 10 mg PO q Day
Immunotherapy
Sipuleucel-T (Provenge)
3 doses (>50 million autologous CD54+ activated cells/dose) IV over 60 min at approximately 2-week intervals
Pembrolizumab (Keytruda)
200 mg IV q3 Weeks OR 400 mg q6 Weeks OR 400 mg q6 Weeks until disease progression, unacceptable toxicity, or up to 24 months without disease progression.
Radiopharmaceuticals
Radium-223 (Xofigo)
50 kBq (1.35 microcurie) per kg body weight, IV, given at 4 week intervals for 6 injections.
Prostate Cancer Bone Health
Calcium
1000-1200 mg per day
Vitamin D
1000 IU
Zoledronic acid (Zometa, Reclast):
Osteoporosis-related fracture prevention:
Reclast
5 mg IV over >15 minutes every year
Bone metastasis from solid tumors:
Zometa
4 mg as a single-use intravenous infusion over > 15 minutes every 3-4 weeks for patients with creatinine clearance of greater than 60 mL/min.
Denosumab (Prolia, Xgeva):
Androgen deprivation induced bone loss:
Prolia
60 mg SC q6months
Bone metastasis from solid tumors:
Xgeva
120 mg SC q4Weeks
Treatment Options for Bothersome Hot Flashes
Megestrol acetate
20 mg, twice per day. Can be reduced to 5 mg bid
Cyproterone acetate
Start at 50 mg/day. May be titrated to 300 mg/day
Venlafaxine
12.5 mg, twice daily
Gabapentin
900 mg daily (300 mg TID).Start with 300 and get to 900 mg on day 3