The American Society of Clinical Oncology has released a provisional clinical opinion on second-line hormonal therapy for chemotherapy-naïve men with castration-resistant prostate cancer (CRPC) who are asymptomatic or have minimal symptoms.

The authors looked at 6 phase 3 randomized controlled trials and relied on expert consensus opinion. Among the recommendations:

• Maintain castrate state indefinitely.
• Consider second-line hormonal therapy only in patients with nonmetastatic CRPC at high risk for metastatic disease.
• After addressing potential harms, benefits, costs, and patient preferences, if appropriate, offer enzalutamide or abiraterone plus prednisone in patients with radiographic evidence of metastases and minimal symptoms.
• There is no optimal order of hormonal therapies for CRPC beyond second-line treatment.
• It is reasonable to offer prostate-specific antigen testing every 4 to 6 months in men without metastases.
• In general, routine radiographic restaging is not recommended but can be considered for patients at risk for metastases or who exhibit symptoms or other evidence of progression.