Warning

Treatment of castration resistant metastatic prostate cancer depends on prior therapies the patient has already received.

Please refer to the appropriate treatment page below based on the patient's prior treatment.

HRD/BRCA testing is encouraged where possible.

First line ARPIs (androgen receptor pathway inhibitors) can be switched to an alternative due to patient intolerance, but ARPIs should not be used in sequence in the event of disease progression during ARPI treatment.

The printing of visual pathways is strongly discouraged, due to the inability to print all relevant information contained within and behind the pathways. Any user choosing to do so must acknowledge that the information may be incomplete and that essential context may be missing from a printed or reproduced pathway.
Author Rob Jones (on behalf of SACT subgroup) Reviewer Alan McNeill

Date of creation

Update

28/05/2025

27/08/2025

Version number 1.1
Description of last update
Talazoparib in combination with enzalutamide added for metastatic castration-resistant prostate cancer.
Addition made to: "Prior LHRH analogue alone", "Prior docetaxel (no prior ARPI)" and "Progression during Androgen Receptor Pathway Inhibitor Therapy (ARPI)" pathways. Minor updates made to pathways for clarity around this change.
Review Date 28/05/2028 Contact nss.scottishcancernetwork@nhs.scot
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Editorial Information

Last reviewed: 28/05/2025

Next review date: 28/05/2028

Author(s): Rob Jones, on behalf of SACT subgroup.

Reviewer name(s): Alan McNeill.