{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,31]],"date-time":"2026-10-31T02:20:28Z","timestamp":1793413228732,"version":"4.5.0"},"reference-count":130,"publisher":"American Society of Clinical Oncology (ASCO)","issue":"20","content-domain":{"domain":["ascopubs.org"],"crossmark-restriction":true},"short-container-title":["JCO"],"published-print":{"date-parts":[[2025,7,10]]},"abstract":"<jats:p>\n                    <jats:italic toggle=\"yes\">ASCO Guidelines provide recommendations with comprehensive review and analyses of the relevant literature for each recommendation, following the guideline development process as outlined in the<\/jats:italic>\n                    <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/society.asco.org\/practice-patients\/guidelines\/guideline-methodology\">\n                      <jats:italic toggle=\"yes\">ASCO Guidelines Methodology Manual<\/jats:italic>\n                    <\/jats:ext-link>\n                    <jats:italic toggle=\"yes\">. ASCO Guidelines follow the<\/jats:italic>\n                    <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/society.asco.org\/about-asco\/legal\/conflict-interest-coi\">\n                      <jats:italic toggle=\"yes\">ASCO Conflict of Interest Policy for Clinical Practice Guidelines<\/jats:italic>\n                    <\/jats:ext-link>\n                    .\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:italic toggle=\"yes\">\n                      Clinical Practice Guidelines and other guidance (\u201cGuidance\u201d) provided by ASCO is not a comprehensive or definitive guide to treatment options. It is intended for voluntary use by clinicians and should be used in conjunction with independent professional judgment. Guidance may not be applicable to all patients, interventions, diseases or stages of diseases. Guidance is based on review and analysis of relevant literature, and is not intended as a statement of the standard of care. ASCO does not endorse third-party drugs, devices, services, or therapies and assumes no responsibility for any harm arising from or related to the use of this information. See complete disclaimer in\n                      <jats:xref ref-type=\"app\">Appendix 1<\/jats:xref>\n                      and\n                      <jats:xref ref-type=\"app\">2<\/jats:xref>\n                      (online only) for more\n                    <\/jats:italic>\n                    .\n                  <\/jats:p>\n                  <jats:sec>\n                    <jats:title>PURPOSE<\/jats:title>\n                    <jats:p>To provide evidence-based recommendations for patients with metastatic castration-resistant prostate cancer (mCRPC).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>An Expert Panel including patient representation completed a systematic review of the evidence and made recommendations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>\n                      Depending upon prior treatment received, androgen receptor pathway inhibitors (ARPIs: enzalutamide, abiraterone with prednisone), poly(ADP-ribose) polymerase inhibitors (PARPi), chemotherapeutic agents (docetaxel, cabazitaxel), radiopharmaceuticals (radium 223,\n                      <jats:sup>177<\/jats:sup>\n                      Lu-prostate-specific membrane antigen [PSMA]-617), and sipuleucel-T have demonstrated an overall survival (OS) benefit for patients with mCRPC. For patients with\n                      <jats:italic toggle=\"yes\">BRCA1<\/jats:italic>\n                      \/\n                      <jats:italic toggle=\"yes\">2<\/jats:italic>\n                      alterations who did not receive prior ARPI, the combination of PARPi and ARPI (talazoparib + enzalutamide, olaparib and\/or niraparib + abiraterone) has shown clinical benefit. For patients with\n                      <jats:italic toggle=\"yes\">BRCA1<\/jats:italic>\n                      \/\n                      <jats:italic toggle=\"yes\">2<\/jats:italic>\n                      alterations who received prior ARPI or ARPI followed by docetaxel, olaparib showed OS benefit. In select patients with microsatellite instability-high\/mismatch repair-deficient, pembrolizumab showed clinical efficacy.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RECOMMENDATIONS<\/jats:title>\n                    <jats:p>\n                      Prior systemic therapy for castration-sensitive prostate cancer will determine subsequent therapy used for mCRPC. Continue androgen-deprivation therapy for patients with mCRPC indefinitely. Early adoption of somatic genetic testing and palliative care is recommended. Patients with mCRPC and bony metastases should receive a bone-protective agent. The panel recommends the combination of ARPI with PARPi in patients with\n                      <jats:italic toggle=\"yes\">BRCA1<\/jats:italic>\n                      \/\n                      <jats:italic toggle=\"yes\">2<\/jats:italic>\n                      alterations who did not receive prior ARPI. For patients who received prior ARPI, the panel recommends docetaxel chemotherapy. The panel recommends\n                      <jats:sup>177<\/jats:sup>\n                      Lu-PSMA-617 or cabazitaxel chemotherapy for patients who receive prior ARPI and docetaxel chemotherapy. For patients with\n                      <jats:italic toggle=\"yes\">BRCA1<\/jats:italic>\n                      \/\n                      <jats:italic toggle=\"yes\">2<\/jats:italic>\n                      alterations who received prior ARPI, the panel recommends PARPi monotherapy. Radium 223 is recommended for patients with symptomatic bone\u2013only disease. Evidence for optimal sequencing for mCRPC regimens is lacking.\n                    <\/jats:p>\n                    <jats:p>\n                      Additional information is available at\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"http:\/\/www.asco.org\/genitourinary-cancer-guidelines\">www.asco.org\/genitourinary-cancer-guidelines<\/jats:ext-link>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1200\/jco-25-00007","type":"journal-article","created":{"date-parts":[[2025,5,2]],"date-time":"2025-05-02T15:59:26Z","timestamp":1746201566000},"page":"2311-2334","update-policy":"https:\/\/doi.org\/10.1200\/crossmark","source":"Crossref","is-referenced-by-count":73,"title":["Systemic Therapy in Patients With Metastatic Castration-Resistant Prostate Cancer: ASCO Guideline Update"],"prefix":"10.1200","volume":"43","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7244-5602","authenticated-orcid":true,"given":"Rohan","family":"Garje","sequence":"first","affiliation":[{"name":"Miami Cancer Institute, Baptist Health South Florida, Miami, FL"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4249-0311","authenticated-orcid":true,"given":"Irbaz Bin","family":"Riaz","sequence":"additional","affiliation":[{"name":"Mayo Clinic, Phoenix, AZ"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Syed Arsalan Ahmed","family":"Naqvi","sequence":"additional","affiliation":[{"name":"Mayo Clinic, Phoenix, AZ"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2786-2925","authenticated-orcid":true,"given":"R. 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