2026 ASCO动态指南：转移性去势抵抗性前列腺癌的全身治疗（2026.V1）

Systemic Therapy in Patients With Metastatic Castration-Resistant Prostate Cancer: ASCO Living Guideline, Version 2026.1

Mary-Ellen Taplin, MD, FASCO$^{1}$]; Irbaz Bin Riaz, MD, PhD$^{2}$; R. Bryan Rumble, MSc$^{3}$; SDy Syed Arsalan Ahmed Naqvi, MD$^{2}$; Thomas A. Hope, MD$^{4}$; Mariane Fontes Dias, MD$^{5}$; Huan He, PhD$^{6}$; Sebastien J. Hotte, MD, MSc$^{7}$; HD; Hamid Emamekhoo, MD$^{8}$; M. Hassan Murad, MD, MPH$^{9}$; Paul Celano, MD, FASCO$^{10}$; Terry M. Kungel, MBA$^{11}$; Steve Hentzen, BS$^{12}$; Michael Thomas Serzan, MD$^{1}$; and Rahul A. Parikh, PhD, MBBS$^{13}$; HD

DOI https://doi.org/10.1200/JCO-25-02693

ABSTRACT

Living guidelines are developed for selected topic areas with rapidly evolving evidence that drives frequent change in recommended clinical practice. Living guidelines are updated on a regular schedule by a standing expert panel that systematically reviews the health literature on a continuous basis, as described in the ASCO Guidelines Methodology Manual. ASCO Living Guidelines follow the ASCO Conflict of Interest Policy Implementation for Clinical Practice Guidelines. Living Guidelines and updates are not intended to substitute for independent professional judgment of the treating clinician and do not account for individual variation among patients. See appendix for disclaimers and other important information (Appendix 1 and Appendix 2). Updates are published regularly and can be found at www.asco.org/genitourinary-cancer-guidelines.

ACCOMPANYING CONTENT

Article, 10.1200/ JCO-25-00007

Appendix

Data Supplement

Accepted November 24, 2025 Published January 20, 2026

Evidence Based Medicine

Committee approval:

November 7, 2025

J Clin Oncol 00:1-4

© 2026 by American Society of

Clinical Oncology

 View Online Article

BACKGROUND

In 2025, ASCO launched the living clinical practice guideline on systemic therapy in patients with metastatic castration-resistant prostate cancer (CRPC). Based on new evidence, this version of the systemic therapy in patients with metastatic CRPC (mCRPC) living guideline provides updated recommendations based on latest evidence. Refer to Appendix Table A1 (online only) for a list of Expert Panel members, Appendix Table A2 for the full list of recommendations, and revised Appendix Figures A1-A4 for the updated algorithms. Appendix Table A3 presents the summary of findings table. The ASCO Guidelines Methodology Manual (available at www.asco.org/guideline-methodology) and Supplement provide additional information.

RESULTS

As of August 1, 2025, a total of 204 references have been identified as eligible for the living systematic review which included 21 new or updated references since the first

iteration of the guideline. Reports from six phase III clinical trials were deemed relevant for further review by the Expert Panel (Appendix Table A1): TALAPRO-2,$^{1}$,$^{2}$ EORTC 1333/PEACE-3,$^{3}$ CONTACT-02,$^{4}$,$^{5}$ KEYNOTE-641,$^{6}$ KEYNOTE-921,$^{7}$ and MAGNITUDE.$^{8}$ Of these, four were new studies (EORTC 1333/PEACE-3, 1333/PEACE-641, 2, KEYNOTE-921), two were updates of previously published studies (TALAPRO-2 and MAGNITUDE). One additional trial (PSMAfore$^{9}$) was re-reviewed in light of the recent US Food and Drug Administration (FDA) approval of lutetium-177-PSMA-617 ($^{177}$Lu-PSMA-617) before docetaxel therapy. Evidence supporting unchanged recommendations is reviewed in the previous publication of this guideline.$^{10}$

# UPDATED RECOMMENDATIONS

# Patients Previously Treated With ADT Alone in Castration-Sensitive or Nonmetastatic CRPC Setting and Whose Disease Has Progressed to mCRPC

See revised Fig A1: Algorithm for patients previously treated with androgen deprivation therapy (ADT) alone.

Taplin et al

Recommendation 1.1.3

The Panel recommends either enzalutamide or chemotherapy using docetaxel for patients with visceral disease (lung and/or liver metastases) and regardless of homologous recombination repair (HRR) alterations (please refer to 1.1.1 and 1.1.2 for preferred recommendations in patients with HRR alterations; Evidence quality: High; Strength of recommendation: Strong).

The panel recommends abiraterone with prednisone, darolutamide, apalutamide, or cabazitaxel in selected patients (see Practical Information; Evidence quality: Low; Strength of recommendation: Conditional).

Practical information for recommendation 1.1.3. Although there are limited data for abiraterone with prednisone, darolutamide, or apalutamide for patients with visceral disease in the mCRPC setting, these agents can be used as alternatives if there are concerns about side effects or drug interactions. Cabazitaxel may be used if allergic reactions or toxicity like peripheral neuropathy which precludes the use of docetaxel. The choice between an androgen receptor pathway inhibitor (ARPI) and chemotherapy may depend on the patient's health, their ability to tolerate chemotherapy, the presence of symptoms and/or visceral disease, accessibility, cost, and the patient's preference, especially if they are averse to chemotherapy.

Recommendation 1.1.4

The Panel recommends docetaxel, abiraterone plus prednisone, enzalutamide with radium 223, or sipuleucel-T for patients with mCRPC without visceral metastases. The panel recommends radium 223 monotherapy for patients with symptomatic bone-only disease (lymph node <3 cm; Evidence quality: Moderate; Strength of recommendation: Strong).

Practical information for recommendation 1.1.4. Unless contraindicated, the use of bone-protecting agents is strongly recommended in all patients receiving radium 223 (See Principle of Practice, item 6). Symptomatic disease is defined as consistent use of pain medications or undergoing external-beam radiation therapy for cancer-related bone pain. The Panel recommends educating patients and caregivers regarding the lack of benefit in objective intermediate measurable end points (prostate-specific antigen [PSA] levels, radiographic changes) associated with the use of sipuleucel-T. Enzalutamide monotherapy instead of enzalutamide with radium is an option in the presence of visceral metastasis or contraindications to abiraterone or radium 223.

Patients Previously Treated With ADT and an ARPI and Whose Disease Has Progressed to mCRPC

See revised Fig A2: Algorithm for patients previously treated with ADT and an ARPI.

Recommendation 1.2.2.1

The Panel recommends using docetaxel chemotherapy, radium 223, or $^{177}$Lu-PSMA-617 (for patients with a prostate-specific membrane antigen [PSMA]–positive positron emission tomography scan) for patients regardless of HRR alterations. (Evidence quality: Moderate; Strength of recommendation: Strong)

Practical information for recommendation 1.2.2.1. Cabazitaxel may be offered to selected patients if they have an allergic reaction or toxicity like peripheral neuropathy which precludes the use of docetaxel.

Recommendation 1.2.3

The Panel recommends sipuleucel-T or local therapies per Recommendations 1.1.4 or 1.1.7, respectively, for selected patients. (Evidence quality: Moderate; Strength of recommendation: Conditional).

Patients Previously Treated With ADT and Docetaxel and Whose Disease Has Progressed to mCRPC

See Fig A3: Algorithm for patients previously treated with ADT and docetaxel.

Recommendation 1.3.2

The Panel recommends either an ARPI such as abiraterone with prednisone or enzalutamide, or enzalutamide with radium 223, or chemotherapy with cabazitaxel (for patients regardless of HRR alterations). (Evidence quality: Moderate; Strength of recommendation: Strong; Conditional for radium 223 with enzalutamide).

Practical information for recommendation 1.3.2. The Panel recommends either abiraterone with prednisone, enzalutamide, enzalutamide with radium 223, or cabazitaxel. Which treatment is offered depends on the patient's clinical status, presence or absence of symptoms from metastatic disease, cost and drug availability, and ability to tolerate therapy. Docetaxel rechallenge may be offered to patients with a favorable response to docetaxel (patients who received initial docetaxel therapy and achieved a favorable PSA nadir and durable response before clinical or radiologic progression) in the castration-sensitive prostate cancer setting.

Patients Previously Treated With ADT, ARPI, and Docetaxel and Dease Has Progressed to mCRPC

See Fig A4: Algorithm for patients previously treated with ADT, ARPI, and docetaxel.

Recommendation 1.4.1

The Panel recommends $^{177}$Lu-PSMA-617 for PSMA-positive disease or radium 223 for PSMA-negative disease or

Systemic Therapy in Patients With mCRPC

chemotherapy using cabazitaxel. (Evidence quality: Moderate; Strength of recommendation: Strong)

Evidence Review

Overall survival (OS) and radiographic progression-free survival (rPFS) analysis for the combination of talazoparib with enzalutamide versus placebo with enzalutamide on the phase III TALAPRO-2$^{1,2}$ trial were updated. Median OS at 52.5 months of follow-up was significantly improved for talazoparib with enzalutamide (45.8 months, 95% CI, 39.4 to 50.8) compared with 37.0 months (95% CI, 34.1 to 40.4) for the enzalutamide arm. The improvement in OS was statistically significant for patients with HRR deficiency (hazard ratio [HR], 0.55 [95% CI, 0.36 to 0.83]; P = .0035) while not statistically significant for patients without HRR deficiency (HR, 0.88 [95% CI, 0.71 to 1.08]; P > .22).

In the randomized phase III PSMAfore$^{9}$ clinical trial, $^{177}$LuPSMA-617 (7.4 GBq once every 6 weeks for six cycles) was compared with ARPI switch therapy in 4.68 patients with taxane–naïve CRPC. The median rPFS was 9.3 months for $^{177}$LuPSMA-617 versus 5.5 months for the ARPI change with a HR of 0.41 (95% CI, 0.29 to 0.56), P < .001. The median OS was similar 23.7 months for $^{177}$LuPSMA-617 and 23.8 months for ARPI change arm with a HR of 0.91 (95% CI, 0.72 to 1.14; P = .2). A large proportion of patients, 57%, on the ARPI change arm crossed over to receive $^{177}$Lu-PSMA-617. PSA response rate and overall response rates were significantly higher in the $^{177}$LuPSMA-617 arm compared with the ARPI change arm. Dry mouth, fatigue, nausea, diarrhea, and cytopenias were common side effects associated with $^{177}$Lu-PSMA-617. $^{177}$LuPSMA-617 delayed worsening of health-related quality of life, pain, and symptomatic skeletal metastases.

KEYNOTE-921$^{7}$ is a large phase III clinical trial which compared the combination of pembrolizumab with docetaxel with docetaxel alone in 1,030 patients with mCRPC whose disease progressed on ADT and ARPI. The addition of pembrolizumab to docetaxel did not improve OS (19.6 months [95% CI, 18.2 to 20.9] v 19.0 months [95% CI, 17.9 to 20.9]) or rPFS (8.6 months [95% CI, 8.3 to 10.2] v 8.3 months [95% CI, 8.2 to 8.5]) compared with docetaxel alone.

AFFILIATIONS

$^{1}$Dana-Farber Cancer Institute, Boston, MA $^{2}$Mayo Clinic, Phoenix, AZ $^{3}$American Society of Clinical Oncology, Alexandria, VA $^{4}$University of California San Francisco, San Francisco, CA $^{5}$Oncoclinicas&Co-Medica Scientia Innovation Research (MEDSIR), Latin America Cooperative Group (LACOG)-Genito-Urinary, Rio de Janeiro, Brazil $^{6}$Yale University, New Haven, CT $^{7}$McMaster University, Hamilton, ON, Canada $^{8}$University of Wisconsin, Madison, WI

In the PEACE-3$^{3}$ trial, a combination of radium 223 (six cycles once every 4 weeks) with enzalutamide was compared with enzalutamide alone in 44.6 patients with metastatic castrate-resistant prostate cancer with bony and nodal metastatic disease. Patients with visceral metastatic disease were excluded, and the use of bone protective agents (zoledronic acid or denosumab) was mandatory. Median rPFS was significantly better for the combination; 19.4 months (95% CI, 0.54 to 0.87) compared with 16.4 months (95% CI, 13.8 to 19.2) for enzalutamide (HR, 0.69 [95% CI, 0.54 to 0.87]; P = .0009). The median OS was 42.3 (95% CI, 32.8 to 54.4) months with the combination of radium 223 with enzalutamide compared with 35 months (95% CI, 28.8 to 38.9) with enzalutamide (HR, 0.69 [95% CI, 0.52 to 0.90]; P = .0031). Final OS analysis is currently pending. Hypertension, fatigue, bone fractures, and cyto-penias were common side effects associated with the use of radium 223 with enzalutamide.

The panel acknowledges results of the phase III CONTACT-02,4,5 clinical study which evaluated the combination of cabozantinib with atezolizumab compared with ARPI switch therapy. In patients with mCRPC with measurable extra-pelvic soft tissue metastases, cabozantinib with atezolizumab map was associated with improved PFS 6.3 months versus 4.2 months for ARPI switch. Median OS was not statistically improved (HR, 0.89 [95% CI, 0.72 to 1.10]; P = .3) with cabozantinib and atezolizumab (median 14.8 months [95% CI, 1.4 to 16.7] v the ARPI switch arm 15.0 months [95% CI, 13.0 to 18.5]), and serious adverse events and discontinuation rates were higher in the cabozantinib with atezolizumab arm compared with the ARPI switch arm.

ASCO believes that cancer clinical trials are vital to inform medical decisions and improve cancer care and that all patients should have the opportunity to participate.

ADDITIONAL RESOURCES

Additional information including a supplement, clinical tools, and resources can be found at www.asco.org/genourinary-cancer-guidelines. Patient information is available at www.cancer.org.

$^{9}$Mayo Clinic, Rochester, MN $^{10}$Greater Baltimore Medical Center (GBMC), Towson, MD $^{11}$Woolwich, ME $^{12}$Leawood, KS $^{13}$University of Kansas Medical Center, Westwood, KS

CORRESPONDING AUTHOR

American Society of Clinical Oncology; e-mail: guidelines@asco.org.

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EDITOR'S NOTE

This American Society of Clinical Oncology (ASCO) Living Clinical Practice Guideline provides recommendations, with review and analysis of the relevant literature for each recommendation. Additional information, including links to patient information at www.cancer.org, is available at www.asco.org/genitourinary-cancer-guidelines.

EQUAL CONTRIBUTION

M.-E.T. and R.A.P. were Expert Panel Co-Chairs.

SUPPORT

Dr I.B.R. was supported in part by National Institute of Health U24 grant (U24264265879-01-1) and Carolyn Ann Kennedy Bacon Fund.

AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST

Disclosures provided by the authors are available with this article at DOI https://doi.org/10.1200/JCO-25-02693.

AUTHOR CONTRIBUTIONS

Conception and design: All authors Administrative support: R. Bryan Rumble Provision of study materials or patients: All authors Collection and assembly of data: All authors Data analysis and interpretation: All authors Manuscript writing: All authors Final approval of manuscript: All authors Accountable for all aspects of the work: All authors

ACKNOWLEDGMENT

The authors wish to thank Dr Richard Lee, MD, Dr Himanshu Nagar, MD, MS, Dr Kurt R. Oettel, MD, and the ASCO Evidence Based Medicine Committee for their thoughtful reviews and insightful comments on this guideline update.

REFERENCES

1. Agarwal N, Azad A, Carles J, et al: Final overall survival (OS) with talazoparib (TALA) + enzaltamide (ENZA) as first-line treatment in unselected patients with metastatic castration-resistant prostate cancer (mCRPC) in the phase 3 TALAPRO-2 trial. J Clin Oncol 43, 2025 (suppl 5; LBA18) 2. Liu G, Mu XJ, Fizazi K, et al: Abstract CT231: Identification of a novel agnostic predictive multiomic signature via elastic net/machine Learning in TALAPRO-2 (TP-2), a phase 3 study of talazoparib (TALA) + enzaltamide (ENZA) vs placebo (PBO) + ENZA as first-line (1L) treatment in patients (pts) with metastatic castration-resistant prostate cancer (suppr 7) 3. Tombal B, Choudhury A, Saad F, et al: Enzalutamide plus radium-223 in metastatic castration-resistant prostate cancer: Results of the EORTC 1333/PEACE-3 trial. Ann Oncol 36:1058-1067, 2025 4. Agarwal N, Azad A, Carles J, et al: CONTACT-02: Phase 3 study of cabozantinib (C) plus atezolizumab (A) vs second novel hormonal therapy (NHT) in patients (pts) with metastatic castration-resistant prostate cancer (mCRPC). J Clin Oncol 42, 2024 (suppl 4; abstr 18) 5. Agarwal N, Azad AA, Carles J, et al: Cabozantinib plus atezolizumab in metastatic prostate cancer (CONTACT-02): Final analyses from a phase 3, open-label, randomised trial. Lancet Oncol 26: 860-876, 2025 6. Graff JN, Burotto M, Fong PC, et al: Pembrolizumab plus enzalutamide versus placebo plus enzalutamide for chemotherapy-naive metastatic castration-resistant prostate cancer: The randomized, double-blind, phase III KEYNOTE-641 study. Ann Oncol 36:976-987, 2025 7. Petrylak DP, Ratta R, Matsubara N, et al: Pembrolizumab plus docetaxel versus docetaxel for previously treated metastatic castration-resistant prostate cancer: The randomized, double-blind, phase III KEYNOTE-921 trial. J Clin Oncol 43:1638-1649, 2025 8. Chi KN, Castro E, Attard G, et al: Niraparib and abiraterone acetate plus prednisone in metastatic castration-resistant prostate cancer: Final overall survival analysis for the phase 3 MAGNITUDE trial. Eur Urol Oncol 8:986-998, 2025 9. Morris MJ, Castellano D, Herrmann K, et al: $^{177}$Lu-PSMA-617 versus a change of androgen receptor pathway inhibitor therapy for taxane-naive patients with progressive metastatic castration-resistant prostate cancer (PSMAfore): A phase 3, randomised, controlled trial. Lancet (London, England) 404:1227-1239, 2024

10. Garje R, Riaz IB, Naqvi SAA, et al: Systemic therapy in patients with metastatic castration-resistant prostate cancer: ASCO guideline update. J Clin Oncol 43:2311-2334, 2025 11. Sanders JJ, Temin S, Ghoshal A, et al: Palliative care for patients with cancer: ASCO guideline update. J Clin Oncol 42:2336-2357, 2024

Systemic Therapy in Patients With mCRPC

AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST

Systemic Therapy in Patients With Metastatic Castration-Resistant Prostate Cancer: ASCO Living Guideline, Version 2025.1

The following represents disclosure information provided by authors of this manuscript. All relationships are considered compensated unless otherwise noted. Relationships are self-held unless noted. I = Immediate Family Member, Inst = My Institution. Relationships may not relate to the subject matter of this manuscript. For more information about ASCO's conflict of interest policy, please refer to www.asco.org/rwc or ascopubs.org/jco/authors/author-center.

Open Payments is a public database containing information reported by companies about payments made to US-licensed physicians (Open Payments).

Mary-Ellen Taplin

Honoraria: Janssen-Ortho, UpToDate, Research to Practice, Pfizer, AstraZeneca, Blue Earth Diagnostics, Astellas Pharma, MJH Healthcare Holdings, LLC, Interpublic GIS, Flare Therapeutics, Physicians' Education Resource, Carden Jennings, DAVA Pharmaceuticals, Novartis, Geode Therapeutics, GlaxoSmithKline, Amgen, Axis Medical Education, Laekena

Consulting or Advisory Role: Janssen-Ortho, UpToDate, Pfizer, AstraZeneca, Astellas Pharma, Flare Therapeutics, Blue Earth Diagnostics, Novartis, Geode Therapeutics, Laekna, GlaxoSmithKline, Novartis

Research Funding: Janssen-Ortho (Inst) Travel, Accommodations, Expenses: Advanced Prostate Cancer Society, South West Prostate Cancer Symposium, Prostate Cancer Foundation

Irbaz Bin Riaz

Honoraria: OncLive/MJH Life Sciences, Oncotarget Research Funding: ASCO

Thomas A. Hope

Stock and Other Ownership Interests: RayzeBio, Curium Pharma, Utter Therapeutics, AdvanCell

Honoraria: GE Healthcare, Cardinal Health

Consulting or Advisory Role: Ipsen, Curium Pharma, Blue Earth Diagnostics, Bayer, ITM Isotope Technologies Munich, Lantheus Medical Imaging, Sanofi, AstraZeneca, Molecular Partners, Novartis, Bristol Myers Squibb Company

Research Funding: GE Healthcare (Inst), Philips Healthcare (Inst), Advanced Accelerator Applications (Inst), Clovis Oncology (Inst), Lantheus Medical Imaging (Inst), Janssen Oncology (Inst), Telix Pharmaceuticals (Inst), Novartis (Inst), Bayer (Inst)

Travel, Accommodations, Expenses: GE Healthcare

Mariane Fontes Dias

Honoraria: Janssen, Astellas Pharma, MSD Oncology, AstraZeneca, Bayer, Ipsen, Merck, Novartis, Adium Pharma, Libbs Consulting or Advisory Role: Merck, MSD Oncology Speakers' Bureau: MSD Oncology, Astellas Pharma Travel, Accommodations, Expenses: Janssen Oncology, MSD Oncology, Ipsen, Astellas Pharma

Sebastien J. Hotte

Honoraria: Astellas Scientific and Medical Affairs Inc, Bayer, Advanced Accelerator Applications/Novartis

Consulting or Advisory Role: Janssen, Astellas Pharma, Pfizer, Bayer, Merck, Novartis Canada Pharmaceuticals Inc

Research Funding: AstraZeneca (Inst), Merck (Inst), Bristol Myers Squibb (Inst), Janssen Oncology (Inst), Ayala Pharmaceuticals (Inst), Pfizer (Inst), Astellas Pharma (Inst), Bristol Myers Squibb (Inst), Seagen (Inst), SignalChem (Inst), ESSA (Inst)

Hamid Emamekhoo

Consulting or Advisory Role: Eisai, Bristol Myers Squibb Company, Cardinal Health

M. Hassan Murad

Employment: Mayo Clinic

Research Funding: Endocrine Society, ASH, Society for Vascular Surgery

Steve Hentzen

Honoraria: Masonic Cancer Alliance, PlatformQ Health, Pharma (Inst), Grail (Inst)

Michael Thomas Serzan

Consulting or Advisory Role: Eisai Europe, Exelixis, Ecancer, AstraZeneca, Dana Oncology

Lantheus

Stock and Other Ownership Interests: IBRX (I) Patents, Royalties, Other Intellectual Property: Patents on DNA repair pathways in cancer. I do not receive any royalties for the same No other potential conflicts of interest were reported.

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APPENDIX 1. GUIDELINE DISCLAIMER

The Clinical Practice Guidelines and other guidance published herein are provided by ASCO to assist clinicians in clinical decision making. The information herein should not be relied upon as being complete or accurate, nor should it be considered as inclusive of all proper treatments or methods of care or as a statement of the standard of care. With the rapid development of scientific knowledge, new evidence may emerge between the time information is developed and when it is published or read. The information is not continually updated and may not reflect the most recent evidence. The information addresses only the topics specifically identified therein and is not applicable to other interventions, diseases, or stages of diseases. This information does not mandate any particular course of medical care. Further, the information is not intended to substitute for the independent professional judgment of the treating clinician, as the information does not account for individual variation among patients. Recommendations specify the level of confidence that the recommendation reflects the net effect of a given course of action. The use of words like must, must not, should and should not indicates that a course of action is recommended or not recommended for either most or many patients, but there is latitude for the treating physician to select other courses of action in individual cases. In all cases, the selected course of action should be considered by the treating clinician in the context of treating the individual patient. Use of the information is voluntary. ASCO does not endorse third party drugs, devices, services, or therapies used to diagnose, treat, monitor, manage, or alleviate health conditions. Any use of a

brand or trade name is for identification purposes only. ASCO provides this information on an "as is" basis and makes no warranty, express or implied, regarding the information. ASCO specifically disclaims any warranties of merchantability or fitness for a particular use or purpose. ASCO assumes no responsibility for any injury or damage to persons or property arising out of or related to any use of this information, or for any errors or omissions.

APPENDIX 2. GUIDELINE AND CONFLICTS OF INTEREST

The Expert Panel was assembled in accordance with ASCO's Conflict of Interest Policy Implementation for Clinical Practice Guidelines (Policy, found at www.asco.org/guideline-methodology). All members of the Expert Panel completed ASCO's disclosure form, which requires disclosure of financial and other interests, including relationships with commercial entities that are reasonably likely to experience direct regulatory or commercial impact as a result of promulgation of the guideline for disclosure for disclosure include employment; leadership; stock or other ownership; honoraria, consulting or advisory role; speaker's bureau; research funding; patents, royalties, other intellectual property; expert testimony; travel, accommodations, expenses; and other relationships. In accordance with the Policy, the majority of the members of the Expert Panel did not disclose any relationships constituting a conflict under the Policy.

|Name|Affiliation|Area of Expertise| |---|---|---| |Rahul A. Parikh, MBBS, PhD, Cochair Group 1|University of Kansas Medical Center, Westwood, KS|Medical Oncology| |Mary-Ellen Taplin, MD, FASCO, Cochair Group 1|Dana-Farber Cancer Institute, Boston, MA|Medical Oncology| |Rohan Garje, MD, Cochair Group 2|Miami Cancer Institute, Baptist Health South Florida, Miami, FL|Medical Oncology| |Irbaz Bin Riaz, MD, PhD, Cochair Group 2|Mayo Clinic, Phoenix, AZ|Medical Oncology/Informatics| |Arnab Basu, MBBS, MPH|University of Alabama at Birmingham, Birmingham, AL|Medical Oncology| |Lisa Bodei, PhD, MD|Weill Cornell Medical College of Cornell University, Memorial Sloan Kettering Cancer Center, New York, NY|Nuclear Medicine| |Alan H. Bryce, MD|City of Hope Cancer Center, Goodyear, AZ|Medical Oncology| |Paul Celano, MD, FASCO|Greater Baltimore Medical Center (GBMC), Towson, MD|Medical Oncology| |Vijay Kumar Damarla, MD, MPH|Illinois Cancercare PC, Ottawa, IL|Medical Oncology| |Abdul Rahman Agha Doreid El Kinge, MBBS|NMC Royal Hospital Sharjah, United Arab Emirates|Medical Oncology| |Hamid Emamekhoo, MD|University of Wisconsin, Madison, WI|Medical Oncology| |Mariane Fontes Dias, MD|Oncoclinicas&Co-Medica Scientia Innovation Research (MEDSIR), Latin America Cooperative Group (LACOG)-Genito-Urinary, Rio de Janeiro, Brazil|Medical Oncology| |Huan He, PhD|Yale University, New Haven, CT|Epidemiology/Informatics| |Steve Hentzen, BS|Leawood, KS|Patient Representative| |Daniel Herchenhorn, MD, PhD|Instituto D'Or/Oncologia D'Or, Latin America Cooperative Group (LACOG)-Genito-Urinary, Rio de Janeiro, Brazil|Medical Oncology| |Thomas A. Hope, MD|University of California, San Francisco, San Francisco, CA|Interventional/Diagnostic Radiology| |Sebastien J. Hotte, MD, MSc|McMaster University, Hamilton, ON, Canada|Medical Oncology| |Terry M. Kungel, MBA|Woolwich, ME|Patient Representative| |Hongfang Liu, PhD|Mayo Clinic, Phoenix, AZ|Epidemiology/Informatics| |Andrew Loblaw, MD, FASCO|Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada|Radiation Oncology| |Jan Manarite|Fort Myers, FL|Patient Representative| ||(continued on following page)||

Systemic Therapy in Patients With mCRPC

|Name|Affiliation|Area of Expertise| |---|---|---| |Anthony Minter, BS|National Alliance of State Prostate Cancer Coalitions, Los Angeles, CA|Patient Representative| |M. Hassan Murad, MD, MPH|Mayo Clinic, Rochester, MN|Epidemiology/Informatics| |Syed Arsalan Ahmed Naqvi, MD|Mayo Clinic, Phoenix, AZ|Medical Oncology| |Giuseppe Procopio, MD, MEd|Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy|Medical Oncology| |Michael Thomas Serzan, MD|Dana-Farber Cancer Institute, Boston, MA|Medical Oncology/Genomics| |Neha Vapiwala, MD|University of Pennsylvania Abramson Cancer Center, Philadelphia, PA|Radiation Oncology| |Peng Wang, MD, PhD|Ohio State University Wexner Medical Center, Columbus, OH|Medical Oncology| |Elizabeth Wulff-Burchfield, MD|University of Kansas Medical Center, Westwood, KS|Medical Oncology| |Tian Zhang, MD, MHS|Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, TX|Medical Oncology| |R. Bryan Rumble, MSc|American Society of Clinical Oncology, Alexandria, VA|ASCO Practice Guideline Staff (health research methods)|

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TABLE A2. All Recommendations

|Principles of Practice|Practice Statement| |---|---| |General Note. The following recommendations (strong or conditional/weak) and terminology (see the Data Supplement, online only) represent reasonable options for patients depending on clinical circumstances and in the context of individual patient preferences. Recommended care should be accessible to patients whenever possible|| |Principles of practice|1. mCRPC is defined as castrate levels of testosterone (>50 ng/mL or 1.7 nm/L) with evidence of either new or progressive metastatic disease on radiologic assessment or two consecutive rising PSA levels (minimal start value is 1.0 ng/mL) in the setting of existing metastatic disease 2. The Panel recommends both germine and somatic testing for patients with metastatic prostate cancer at the earliest available opportunity. Additional recommendations and discussion regarding the same are available in the Germine and Somatic Genomic Testing for Metastatic Prostate Cancer: ASCO Guideline (Yu EY et al: J Clin Oncol 43:748-758, 2025)| |Principles of practice|3. The Panel recommends personalizing treatment based on prior therapies received during castration-sensitive setting, while also accounting for each patient's clinical status, cancer-related symptoms and signs, therapy-related toxicities, potential drug interactions, cost, and drug availability 4. The Panel recommends continuation of ADT (or surgical castration) to maintain castrate levels of testosterone for every patient with mCRPC 5. The Panel recommends early integration of palliative and supportive care teams for symptom management and to review goals of care for patients with mCRPC. Additional information on the same is available in the Palliative Care for Patients With Cancer: ASCO Guideline Update (Sanders et al:1) 6. The Panel recommends the use of bone-protective agents like denosumab (RANK ligand inhibitor) or zoledronic acid (bisphosphonate) for patients with bone metastases to lower the risk of SREs. Additional recommendations on the same are available in the Bone Health and Bone-Targeted Therapies for Prostate Cancer: ASCO Endorsement of a Cancer Care Ontario Guideline (Saylor PJ, et al: J Clin Oncol 38:1736-1743, 2020) 7. Limited randomized clinical trial data exist for optimal sequencing of therapies for patients with mCRPC, as certain therapies studied in the mCRPC setting are now being used earlier during castration-sensitive disease| |Clinical Question|Recommendation| |For patients previously treated with ADT alone in castration-sensitive or nonmetastatic CRPC setting and whose disease has progressed to meta-static CRPC, the panel recommends (Fig A1: Algorithm for patients previously treated with ADT alone)|1.1.1. The Panel recommends HRR testing before initiation of systemic therapy (see the Germine and Somatic Genomic Testing for Metastatic Prostate Cancer: ASCO Guideline; Yu EY et al: J Clin Oncol 43:748-758, 2025). If positive for BRCA1/2 alterations, then preferred options include either of niraparib + abiratarone, olaparib + abiratarone, or talazarone, or talazarone (A. Tese) Positive, (Evidence quality: Moderate; Strength of recommendation: Strong)| |For patients previously treated with ADT alone in castration-sensitive or nonmetastatic CRPC setting and whose disease has progressed to meta-static CRPC, the panel recommends (Fig A1: Algorithm for patients previously treated with ADT alone)|Practical Information for Recommendation 1.1.1: The Panel recommends personalized treatment based on therapies received during castration-sensitive setting, while also accounting for each patient's clinical status, therapy-related toxicities, potential drug interactions, cost, and drug availability as per Principles of Practice Recommendation 3| |For patients previously treated with ADT alone in castration-sensitive or nonmetastatic CRPC setting and whose disease has progressed to meta-static CRPC, the panel recommends (Fig A1: Algorithm for patients previously treated with ADT alone)|1.1.2. The Panel suggests the combination of talazaporib and enzalutamide for patients with any of the other HRR alterations (PALB2, ATM, ATR, CHEK2, FANCA, RAD51C, NBN, MLH1, MRE11A, CDK12). (Evidence quality: Low, pending further follow up data; Strength of recommendation: Conditional) Practical Information for Recommendation 1.1.2: Responses vary according to individual genes, but the strongest responses are seen in patients with PALB2 and CDK12 alterations in post hoc subgroup analyses 1.1.3. The Panel recommends either enzalutamide or chemotherapy using docetaxel for patients with visceral disease (lung and/or liver metastases) and regardless of HRR alterations (please refer to 1.1 and 1.1 and 2.1 for preferred recommendations in patients with HRR alterations). (Evidence quality: High; Strength of recommendation: Strong) The panel recommends abiraterone with prednisone, daralutamide, apalutamide, or cabazitaxel in selected patients (see Practical Information; Evidence quality: Low; Strength of recommendation: Conditional)| |For patients previously treated with ADT alone in castration-sensitive or nonmetastatic CRPC setting and whose disease has progressed to meta-static CRPC, the panel recommends (Fig A1: Algorithm for patients previously treated with ADT alone)|Practical Information for Recommendation 1.1.3. Although there are limited data for abiraterone with prednisone, daralutamide, or apalutamide for patients with visceral disease in the mCRPC setting, these agents can be used as alternatives if there are concerns about side effects or drug interactions. Cabazitaxel may be used if allergic reactions or toxicity like peripheral neuropathy which precludes the use of docetaxel. The choice between an ARPI and chemotherapy may depend on the patient's health, their ability to tolerate chemotherapy, the presence of symptoms and/or visceral disease, accessibility, cost, and the patient's preference, especially if they are averse to chemotherapy| |For patients previously treated with ADT alone in castration-sensitive or nonmetastatic CRPC setting and whose disease has progressed to meta-static CRPC, the panel recommends (Fig A1: Algorithm for patients previously treated with ADT alone)|1.1.4. The Panel recommends docetaxel, abiraterone plus prednisone, enzalutamide with radium, or sipuleucel-T for patients with mCRPC without visceral metastases. The panel recommends radium 223 monotherapy for patients with symptomatic one-only disease (lymph node <3 cm; Evidence quality: Moderate; Strength of recommendation: Strong)| |For patients previously treated with ADT alone in castration-sensitive or nonmetastatic CRPC setting and whose disease has progressed to meta-static CRPC, the panel recommends (Fig A1: Algorithm for patients previously treated with ADT alone)|Practical Information for Recommendation 1.1.4: Unless contraindicated, the use of bone-protecting agents is strongly recommended in all patients receiving radium 223 (See Principle of Practice, item 6). Symptomatic disease is defined as consistent use of pain medications or undergoing external-beam radiation therapy for cancer-related bone pain. The Panel recommends educating patients and caregivers regarding the lack of benefit in objective intermediate measurable end points (PSA levels, radiographic changes) associated with the use of sipuleucel-T. Enzalutamide monotherapy instead of enzalutamide with radium is an option in the presence of visceral metastasis or contraindations to abiraterone or radium 223| |For patients previously treated with ADT alone in castration-sensitive or nonmetastatic CRPC setting and whose disease has progressed to meta-static CRPC, the panel recommends (Fig A1: Algorithm for patients previously treated with ADT alone)|1.1.5. The Panel recommends pembrolizumab for patients with MSI-Hoor di m4M after progression on other agents listed previously. (Evidence quality: Moderate; Strength of recommendation: Strong)| |For patients previously treated with ADT alone in castration-sensitive or nonmetastatic CRPC setting and whose disease has progressed to meta-static CRPC, the panel recommends (Fig A1: Algorithm for patients previously treated with ADT alone)|Practical Information for Recommendation 1.1.5: For patients with tumor mutational burden-high (TMB-H≥10 mut/Mb), the Panel recommends considering other therapeutic options listed previously before utilization of pembrolizumab, given modest clinical benefit| |For patients previously treated with ADT alone in castration-sensitive or nonmetastatic CRPC setting and whose disease has progressed to meta-static CRPC, the panel recommends (Fig A1: Algorithm for patients previously treated with ADT alone)|1.1.7. The Panel suggests metastasis-directed therapy in the form of radiation or surgical resection after a multidisciplinary evaluation in selected patients with oligometastatic progression. (Evidence quality: Low, Strength of recommendation: Conditional)| |For patients previously treated with ADT and an ARPI and whose disease has progressed to metastatic CRPC (Fig A2: Algorithm for patients previously treated with ADT and an ARPI)|1.2.1. The Panel recommends using olaparib monotherapy for patients with BRCA1/2 alterations. (Evidence quality: Moderate; Strength of recommendation: Strong)| |For patients previously treated with ADT and an ARPI and whose disease has progressed to metastatic CRPC (Fig A2: Algorithm for patients previously treated with ADT and an ARPI)|Practical Information for Recommendation 1.2.1: Rucaparib may be offered as an alternative to olaparib for selected patients based on clinical judgment and patient preferences, pending availability| |For patients previously treated with ADT and an ARPI and whose disease has progressed to metastatic CRPC (Fig A2: Algorithm for patients previously treated with ADT and an ARPI)|1.2.2. The Panel suggests olaparib monotherapy for patients with any of the other HRR alterations. (Evidence quality: Very Low; Strength of recommendation: Conditional)| |For patients previously treated with ADT and an ARPI and whose disease has progressed to metastatic CRPC (Fig A2: Algorithm for patients previously treated with ADT and an ARPI)|Practical Information for Recommendation 1.2.2: Patients with BRCA1, BRCA2, CDK12, and PALB2 gene alterations experienced the greatest benefit with PARP inhibitors. The data supporting continuation of ARPI with a PARP inhibitor are limited. A second ARPI can be considered based on clinical judgment, patient comorbidities, and factors for slowly progressive disease determined by slowly rising PSA without any radiologic progression or cancer-related symptoms. The Panel suggests referring to Recommendation 1.2.2: for alternate options| |For patients previously treated with ADT and an ARPI and whose disease has progressed to metastatic CRPC (Fig A2: Algorithm for patients previously treated with ADT and an ARPI)|1.2.2.1. The Panel recommends using docetaxel chemotherapy, radium 223, or $^{177}$Lu-PSMA-617 (for patients with a PSMA-positive PET scan) for patients regardless of HRR alterations. (Evidence quality: Moderate; Strength of recommendation: Strong)| |For patients previously treated with ADT and an ARPI and whose disease has progressed to metastatic CRPC (Fig A2: Algorithm for patients previously treated with ADT and an ARPI)|Practical Information for Recommendation 1.2.2.1: Cabazitaxel may be offered to selected patients if they have an allergic reaction or toxicity like peripheral neuropathy which precludes the use of docetaxel| |For patients previously treated with ADT and an ARPI and whose disease has progressed to metastatic CRPC (Fig A2: Algorithm for patients previously treated with ADT and an ARPI)|1.2.3. The Panel recommends sipuleucel-T or local therapies per Recommendations 1.1.4 or 1.1.7, respectively, for selected patients. (Evidence quality: Moderate; Strength of recommendation: Conditional)|

Systemic Therapy in Patients With mCRPC

|Principles of Practice|Practice Statement| |---|---| |For patients previously treated with ADT and docetaxel and whose disease has progressed to metastatic CRPC (Fig A3: Algorism for patients previously treated with ADT and docetaxel)|1.3.1. The Panel recommends following Recommendations 1.1.1 and 1.1.2 for patients with HRR alterations. (Evidence quality: Moderate to Low; Strength of recommendation: Strong)| |For patients previously treated with ADT and docetaxel and whose disease has progressed to metastatic CRPC (Fig A3: Algorism for patients previously treated with ADT and docetaxel)|1.3.2. The Panel recommends either an ARPI such as abiraterone with prednisone or enzalutamide, or enzalutamide with radium 223, or chemotherapy with cabazitaxel (for patients regardless of HRR alterations). (Evidence quality: Moderate; Strength of recommendation: Strong; Conditional for radium 223 with enzalutamide)| |For patients previously treated with ADT and docetaxel and whose disease has progressed to metastatic CRPC (Fig A3: Algorism for patients previously treated with ADT and docetaxel)|Practical Information for Recommendation 1.3.2. The Panel recommends either abiraterone with prednisone, enzalutamide, enzalutamide with radium 223, or cabazitaxel. Which treatment is offered depends on the patient's clinical status, presence or absence of symptoms from metastatic disease, cost and drug availability, and ability to tolerate therapy. Docetaxel rechallenge may be offered to patients with a favorable response to docetaxel (patients who received initial docetaxel therapy and achieved a favorable PSA nadir and durable response before clinical or radiologic progression) in the CSPC setting| |For patients previously treated with ADT, ARPI, and docetaxel and whose disease has progressed to metastatic CRPC (Fig A4: Algorithm for patients previously treated with ADT, ARPI), and docetaxel)|1.4.1. The Panel recommends $^{17}$Lu-PSMA-617 for PSMA-positive disease or radium 223 for PSMA-negative disease or chemotherapy using cabazitaxel. (Evidence quality: Moderate; Strength of recommendation: Strong)| |For patients previously treated with ADT, ARPI, and docetaxel and whose disease has progressed to metastatic CRPC (Fig A4: Algorithm for patients previously treated with ADT, ARPI), and docetaxel)|1.4.2. The Panel recommends olaparib monotherapy for patients with HRR alterations. (Evidence quality: Moderate; Strength of recommendation: Strong)| |For patients previously treated with ADT, ARPI, and docetaxel and whose disease has progressed to metastatic CRPC (Fig A4: Algorithm for patients previously treated with ADT, ARPI), and docetaxel)|Practical Information for Recommendation 1.4.2. As it has demonstrated a PFS benefit, rucaparb may be offered as an alternative to olaparib for selected patients with BRCA1/2 alterations based on clinical judgment and patient preferences, pending availability| |For patients previously treated with ADT, ARPI, and docetaxel and whose disease has progressed to metastatic CRPC (Fig A4: Algorithm for patients previously treated with ADT, ARPI), and docetaxel)|1.4.3. The Panel also recommends radium 223 or pembrolizumab for specific situations outlined earlier (as per Recommendations 1.1.4 and 1.1.5). (Evidence quality: Moderate; Strength of recommendation: Strong)| |For patients previously treated with ADT, ARPI, and docetaxel and whose disease has progressed to metastatic CRPC (Fig A4: Algorithm for patients previously treated with ADT, ARPI), and docetaxel)|1.4.4. The Panel suggests clinical trials, cabazitaxel + carboplatin, carboplatin monotherapy, best supportive care, and hospice care for patients with disease progression despite previously mentioned options. (Evidence quality: Low; carbazitaxel + carboplatin); Low [carboplatin monotherapy]; NA [best supportive care and hospice care]; Strength of recommendation: Conditional)| |What are the treatment options for de novo or treatment-emergent small cell neuroendrocinic carcinoma of the treatment-emergent small cell neuroendrocinic carcinoma of the treatment-emergent small cell neuroendrocinic carcinoma of the treatment-emergent small cell neuroendrocinic carcinoma of the treatment-emergent small cell neuroendrocinic carcinoma of the treatment-emergent small cell neuroendrocinic carcinoma of the treatment-emergent small cell neuroendrocinic carcinoma of the treatment-emergent small cell neuroendrocinic carcinoma of the treatment-emergent small cell neuroendrocinic carcinoma of the treatment-emergent small cell neuroendrocinic carcinoma of the treatment-emergent small cell neuroendrocinic carcinoma of the treatment-emergent small cell neuroendrocinic carcinoma of the treatment-emergent small cell neuroendrocinic carcinoma of the treatment-emergent small cell neuroendrocinic carcinoma of the treatment-emergent small cell neuroendrocinic carcinoma of the treatment-emergent small cell neuroendrocinic carcinoma of the treatment-||

NOTE. The strength of the recommendation is defined as follows. Strong: In recommendations for an intervention, the desirable effects of an intervention outweigh its undesirable effects. In recommendations against an intervention, the undesirable effects of an intervention outweigh its desirable effects. All or almost all informed people would make the recommended choice for or against an intervention. Conditional/weak: In recommendations for an intervention, the desirable effects probably outweigh the undesirable effects, but appreciable uncertainty exists. In recommendations against an intervention, the undesirable effects probably outweigh the desirable effects, but appreciable uncertainty exists. Most informed people would choose the recommended course of action, but a substantial number would not.

Abbreviations: $^{177}$Lu-PSMA-617, lutetium-177/PSMA-617; ADT, androgen-deprivation therapy; ARPI, androgen receptor pathway inhibitor; CAP, chest, abdomen, and pelvis; CMP, comprehensive metabolic panel; CRPC, castration-resistant prostate cancer; CSPC, castration-sensitive prostate cancer, CT, computed tomography; dMMR, mismatch repair-deficient; HRR, homologous recombination repair; mCRPC, metastatic castration resistant prostate cancer; MSI-high, microsatellite instability-high; NA, not applicable; NGS, next-generation sequencing; PARP, poly(ADP-ribose) polymerase; PCWG, Prostate Cancer Working Group; PET, positron emission tomography; PFS, progression-free survival; PSA, prostate-specific antigen; PSMA, prostate-specific membrane antigen; RANK, receptor activator of nuclear factor-kappa B; SRE, skeletal-related event; TMB-H, tumor mutational burden-high.

© 2026 by American Society of Clinical Oncology

|Outcome|Relative Effect, HR (95% CI)|Absolute Risk Estimates|||||| |---|---|---|---|---|---|---|---| |Outcome|Relative Effect, HR (95% CI)|Risk With Control|Risk With Intervention|Risk Difference (95% CI)|Quality of Evidence|Trials Used|Trials Used| |Summary of findings with certainty of evidence for phase III trials in which patients received prior ADT only|||||||| |Patients with BRCA1/2 alterations|||||||| |PARPi + ARPI|PARPi + ARPI|PARPi + ARPI|PARPi + ARPI|PARPi + ARPI|PARPi + ARPI|PARPi + ARPI|PARPi + ARPI| |OS|0.53 (0.29 to 0.95)|556 per 1,000|349 per 1,000|206 fewer per 1,000 (346 fewer to 18 fewer)|$Moderate^{a}$|MAGNITUDE, TALAPRO-2, PROpel|| |PFS|0.33 (0.18 to 0.59)|808 per 1,000|420 per 1,000|388 fewer per 1,000 (551 fewer to 186 fewer)|$Moderate^{a}$|MAGNITUDE, TALAPRO-2, PROpel|| |Talazoparib + enzalutamide|||||||| |OS|0.50 (0.32 to 0.78)|667 per 1,000|423 per 1,000|244 fewer per 1,000 (370 fewer to 91 fewer)|High|TALAPRO-2|TALAPRO-2| |PFS|0.26 (0.16 to 0.42)|667 per 1,000|248 per 1,000|418 fewer per 1,000 (505 fewer to 297 fewer)|High|TALAPRO-2|TALAPRO-2| |Patients with HRR alterations other than BRCA1/2|||||||| |Talazoparib + enzalutamide|||||||| |OS|0.73 (0.52 to 1.02)|609 per 1,000|496 per 1,000|113 fewer per 1,000 (223 fewer to 7 more)|$Moderate^{b}$|TALAPRO-2|TALAPRO-2| |PFS|0.65 (0.47 to 0.91)|617 per 1,000|464 per 1,000|153 fewer per 1,000 (254 fewer to 35 fewer)|High|TALAPRO-2|TALAPRO-2| |Patients without HRR alterations|||||||| |Enzalutamide + radium|||||||| |Overall population:|Overall population:|Overall population:|Overall population:|Overall population:|Overall population:|Overall population:|Overall population:| |OS|0.69 (0.52 to 0.90)|576 per 1,000|447 per 1,000|129 fewer per 1,000 (216 fewer to 38 fewer)|High|EORTC 1333/PEACE-3|EORTC 1333/PEACE-3| |PFS|0.69 (0.54 to 0.87)|714 per 1,000|579 per 1,000|136 fewer per 1,000 (223 fewer to 51 fewer)|High|EORTC 1333/PEACE-3|EORTC 1333/PEACE-3| |Patients who did not receive docetaxel previously|||||||| |PFS|0.64 (0.48 to 0.84)|717 per 1,000|554 per 1,000|163 fewer per 1,000 (263 fewer to 63 fewer)|High|EORTC 1333/PEACE-3|EORTC 1333/PEACE-3| |Summary of findings with certainty of evidence for phase III trials in which patients received prior ADT + docetaxel|||||||| |Patients without HRR alterations|||||||| |Enzalutamide + radium|||||||| |Patients who had docetaxel previously|||||||| |PFS|0.86 (0.57 to 1.31)|708 per 1,000|653 per 1,000|55 fewer per 1,000 (204 fewer to 93 fewer)|$Low^{c}$|EORTC 1333/PEACE-3|EORTC 1333/PEACE-3|

Abbreviations: ADT, androgen deprivation therapy; ARPI, androgen receptor pathway inhibitor; HR, hazard ratio; HRR, homologous recombination repair; OS, overall survival; PFS, progression-free survival.

ªSerious indirectness because of differences in the trial designs and receipt of prior therapy.

ᵇSerious imprecision because of null effect indicating both clinical benefit and harm.

$^{c}$Very serious imprecision because of small sample size and null effect indicating both clinical benefit and harm.

Systemic Therapy in Patients With mCRPC

 Taplin et al

 Systemic Therapy in Patients With mCRPC

 Taplin et al