Prostate Cancer

Regimen Options

Last Updated: 07/02/2026 See Details

NOTE: LEUPROLIDE (LUPRON OR ELIGARD), TRIPTORELIN (TRELSTAR) IS ON PATHWAY.

	Evolent Pathways	Febrile Neutropenic Risk	Emetogenic Risk	References
Neoadjuvant/Adjuvant ± Radiation	leuprolide or triptorelin	Low	Low	NCCN Guidelines® for Prostate Cancer V.5.2026.
	degarelix	Low	Low	NCCN Guidelines® for Prostate Cancer V.5.2026. Shore, ND et al. N Engl J Med 2020;382:2187-2196
High-Risk Metastatic Castration-Sensitive Prostate Cancer (mCSPC)	abiraterone, prednisone and ADT	Low	Low	NCCN Drugs & Biologics Compendium® Prostate Cancer V.5.2026. Fizazi et al. N Engl J Med 2017;377:352-60.
Metastatic Castrate-Sensitive (M1 disease)	degarelix	Low	Low	NCCN Guidelines® for Prostate Cancer V.5.2026. Shore, ND et al. N Engl J Med 2020;382:2187-2196
	darolutamide, docetaxel and androgen-deprivation therapy (ADT) ± prednisone	Low	Low	NCCN Drugs & Biologics Compendium® Prostate Cancer V.5.2026. Smith MR et al. N Engl J Med 2022; 386:1132-1142
	abiraterone, prednisone and androgen-deprivation therapy (ADT) ± docetaxel	Low	Low	NCCN Drugs & Biologics Compendium® Prostate Cancer V.5.2026. Fizazi, K et al. DOI: 10.1016/S0140-6736(22)00367-1 Fizazi K, et al. Lancet 2022; 399: 1695–07
	leuprolide or triptorelin	Low	Low	NCCN Guidelines® for Prostate Cancer V.4.2023. Schweizer MT, MD, et al. Cancer. 2013;119(20):3610-3618.
CASTRATE-RESISTANT/NON-METASTATIC
Non-metastatic Castrate-Resistant w/no radiographic metastases (M0 disease)	enzalutamide	Low	Low	NCCN Guidelines® for Prostate Cancer V.2.2017. Hussain et al. N Engl J Med 2018;378:2465-74
	enzalutamide and leuprolide	Low	Low	NCCN Guidelines® for Prostate Cancer V.2.2017. Hussain et al. N Engl J Med 2018;378:2465-74
	apalutamide	Low	Low	NCCN Guidelines® for Prostate Cancer V.2.2017. Smith et al. N Engl J Med 2018;378:1408-18
	apalutamide and leuprolide	Low	Low	NCCN Guidelines® for Prostate Cancer V.2.2017. Smith et al. N Engl J Med 2018;378:1408-18
	darolutamide	Low	Low	NCCN Guidelines® for Prostate Cancer V.2.2017. Wenzel M, et al. https://doi.org/10.1038/s41391-021-00395-4. Fizazi K et al. N Engl J Med . 2020 Sep 10;383(11):1040-1049.
	darolutamide and leuprolide	Low	Low	NCCN Guidelines® for Prostate Cancer V.2.2017. Wenzel M, et al. https://doi.org/10.1038/s41391-021-00395-4. Fizazi K et al. N Engl J Med . 2020 Sep 10;383(11):1040-1049.
	leuprolide	Low	Low	NCCN Drugs & Biologics Compendium® Prostate Cancer V.2.2017.
	degarelix	Low	Low	NCCN Guidelines® for Prostate Cancer V.5.2026. Shore, ND et al. N Engl J Med 2020;382:2187-2196
CASTRATE-RESISTANT/METASTATIC
Initial or Subsequent Therapy	abiraterone and prednisone	Low	Low	NCCN Guidelines® for Prostate Cancer V.2.2017. Ryan CJ, et al. N Engl J Med. 2013;368(2):138-48. Fizazi K, et al. Lancet Oncol. 2012;13(10):983-92.
	docetaxel and steroid	Intermediate	Low	NCCN Guidelines® for Prostate Cancer V.2.2017. Tannock IF, et al. N Engl J Med. 2004;351(15):1502-12. Berthold DR, et al. J Clin Oncol. 2008;26(2):242-5.
	enzalutamide	Low	Low	NCCN Guidelines® for Prostate Cancer V.2.2017. Scher HI, et al. N Engl J Med. 2012;367(13):1187-97. Beer TM, et al. N Engl J Med. 2014;371(5):424-33.
	apalutamide	Low	Low	NCCN Guidelines® for Prostate Cancer V.2.2017. Smith et al. N Engl J Med 2018;378:1408-18
	leuprolide	Low	Low	NCCN Drugs & Biologics Compendium® Prostate Cancer V.2.2017.
	degarelix	Low	Low	NCCN Guidelines® for Prostate Cancer V.5.2026. Shore, ND et al. N Engl J Med 2020;382:2187-2196
	cabazitaxel 20mg/m2 and steroid	Intermediate	Low	NCCN Drugs & Biologics Compendium® Prostate Cancer V.2.2017. De Wit et al. N Engl J Med. 2019 Dec 26;381(26):2506-2518. a>. Eisenberger M et al. J Clin Oncol. 2017 Oct 1;35(28):3198-3206.
	olaparib (BRCA1/2)	Low	Low	NCCN Drugs & Biologics Compendium® Prostate Cancer V.2.2017. De Bono et al. N Engl J Med 2020; 382:2091-2102.
	Best Supportive Care or Clinical Trial	Not Applicable	Not applicable	NCCN Guidelines® for Supportive Care.
NEUROENDOCRINE METASTATIC
Initial or Subsequent Therapy	cisplatin and etoposide	Low	High	NCCN Guidelines® for Prostate Cancer V.2.2017. Ihde DC, et al. J Clin Oncol. 1994;12(10):2022-34. Sundstrom S, et al. J Clin Oncol. 2002;20(24):4665-72. NCCN Guidelines® for Small Cell Lung Cancer V.2.2017.
	carboplatin and etoposide	Low	High	NCCN Guidelines® for Prostate Cancer V.2.2017. Skarlos D, et al. Ann Oncol. 2001;12(9):1231-8. NCCN Guidelines® for Small Cell Lung Cancer V.2.2017.
	Best Supportive Care or Clinical Trial	Not Applicable	Not applicable	NCCN Guidelines® for Supportive Care.

Neoadjuvant/Adjuvant ± Radiation

Evolent Pathways

leuprolide or triptorelin

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Evolent Pathways

degarelix

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

High-Risk Metastatic Castration-Sensitive Prostate Cancer (mCSPC)

Evolent Pathways

abiraterone, prednisone and ADT

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Metastatic Castrate-Sensitive (M1 disease)

Evolent Pathways

degarelix

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Evolent Pathways

darolutamide, docetaxel and androgen-deprivation therapy (ADT) ± prednisone

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Evolent Pathways

abiraterone, prednisone and androgen-deprivation therapy (ADT) ± docetaxel

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Evolent Pathways

leuprolide or triptorelin

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

CASTRATE-RESISTANT/NON-METASTATIC

Non-metastatic Castrate-Resistant w/no radiographic metastases (M0 disease)

Evolent Pathways

enzalutamide

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Evolent Pathways

enzalutamide and leuprolide

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Evolent Pathways

apalutamide

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Evolent Pathways

apalutamide and leuprolide

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Evolent Pathways

darolutamide

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Evolent Pathways

darolutamide and leuprolide

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Evolent Pathways

leuprolide

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Evolent Pathways

degarelix

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

CASTRATE-RESISTANT/METASTATIC

Initial or Subsequent Therapy

Evolent Pathways

abiraterone and prednisone

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Evolent Pathways

docetaxel and steroid

Febrile Neutropenic Risk

intermediate

Emetogenic Risk

low

References

Evolent Pathways

enzalutamide

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Evolent Pathways

apalutamide

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Evolent Pathways

leuprolide

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Evolent Pathways

degarelix

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Evolent Pathways

cabazitaxel 20mg/m2 and steroid

Febrile Neutropenic Risk

intermediate

Emetogenic Risk

low

References

Evolent Pathways

olaparib (BRCA1/2)

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Evolent Pathways

Best Supportive Care or Clinical Trial

Febrile Neutropenic Risk

Emetogenic Risk

References

NEUROENDOCRINE METASTATIC

Initial or Subsequent Therapy

Evolent Pathways

cisplatin and etoposide

Febrile Neutropenic Risk

low

Emetogenic Risk

high

References

Evolent Pathways

carboplatin and etoposide

Febrile Neutropenic Risk

low

Emetogenic Risk

high

References

Evolent Pathways

Best Supportive Care or Clinical Trial

Febrile Neutropenic Risk

Emetogenic Risk

References

	Regimen	Alternative	References
LOW VALUE REGIMENS (NON-PATHWAY) WITH SUPERIOR ALTERNATIVES
Subsequent Therapy	sipuleucel-T	Alternatives: varies

LOW VALUE REGIMENS (NON-PATHWAY) WITH SUPERIOR ALTERNATIVES

Subsequent Therapy

Regimen

** sipuleucel-T **

Pathways and Low-Value Regimens

Prostate Cancer