OpenOnco · Treatment Plan

Treatment plan — DIS-PROSTATE

PLAN-BMA-MLH1_GERMLINE_PROSTATE-V1 · v1 · 2026-05-04

Patient

BMA-MLH1_GERMLINE_PROSTATE · Algorithm: ALGO-PROSTATE-MCRPC-1L

Clinical significance of mutations (ESCAT)

Tumor-board context — the engine does not use these tiers to rank tracks

✅ Covered biomarkers (matched in KB)

Biomarker	Variant	ESCAT	Evidence	Clinical significance	Drugs	Sources
No clinically actionable variants matched in this profile.

⚠️ Not included in plan

Biomarker	Status
BIO-DMMR-IHC	Not in KB — ask clinician to verify

Treatment options (3 tracks)

Standard plan

★ DEFAULT

Indication

IND-PROSTATE-MCRPC-1L-ARPI

Regimen

ADT + enzalutamide (continuous)

Drugs + NSZU

Leuprolide (DRUG-LEUPROLIDE) 11.25 mg IM q3 months · Continuous · IM ✓ NSZU covered
Enzalutamide (DRUG-ENZALUTAMIDE) 160 mg PO daily · Continuous · PO ✓ NSZU covered

Supportive care

SUP-BONE-HEALTH-PROSTATE

Reason

Engine default per algorithm ALGO-PROSTATE-MCRPC-1L: {'step': 4, 'outcome': False, 'branch': {'result': 'IND-PROSTATE-MCRPC-1L-ARPI', 'notes': 'Fall-through (prior ARPI + prior taxane + PSMA-PET unavailable or negative): ARPI switch (enzalutamide ↔ abiraterone) has modest activity after prior ARPI (cross-resistance common). Consider clinical trial enrollment. NCCN: cabazitaxel or olaparib (if HRR not yet tested) are acceptable alternatives.\n'}, 'fired_red_flags': [], 'winner_red_flag': None}

Aggressive plan

Indication

IND-PROSTATE-MCRPC-1L-PARPI

Regimen

Olaparib monotherapy (mCRPC, HRR-mutant)

Drugs + NSZU

Olaparib (DRUG-OLAPARIB) 300 mg PO BID continuous · Until progression or unacceptable toxicity · PO ⚠ NSZU — not for this indication

Supportive care

SUP-BONE-HEALTH-PROSTATE

Reason

Alternative track presented for HCP consideration

IND-PROSTATE-MCRPC-2L-LU-PSMA

Indication: IND-PROSTATE-MCRPC-2L-LU-PSMA
Regimen: —
Reason: Alternative track presented for HCP consideration

Pre-treatment investigations

Investigations before treatment start · critical / standard / desired · merged across tracks

ID	Name	Priority	Category	Where to order	Needed for
TEST-PSA-SERUM	Serum PSA	Critical	—	—	aggressive, standard
TEST-BONE-SCAN	Whole-body Tc-99m MDP bone scintigraphy	Standard	—	—	aggressive, standard
TEST-GERMLINE-BRCA-PANEL	Germline BRCA1/2 + HRR panel sequencing	Standard	—	CSD Lab: M089	aggressive, standard
TEST-PSMA-PET	PSMA-PET/CT (Ga-68 or F-18)	Standard	—	—	desired (aggressive, standard)
TEST-SOMATIC-HRR-PANEL	Tumor-tissue (or ctDNA) HRR-pathway NGS panel	Standard	—	CSD Lab: M065 CSD Lab ✓ (code TBC)	aggressive
TEST-TESTOSTERONE-SERUM	Serum total testosterone	Standard	—	—	aggressive, standard

Red flags — PRO / CONTRA aggressive

PRO-AGGRESSIVE

Triggers that push toward the aggressive track

Germline or somatic BRCA1/2 mutation OR broader HRR pathway alteration (ATM, CDK12, PALB2, etc.) — predicts PARPi response; opens olaparib/talazoparib indication in mCRPC.RF-PROSTATE-HIGH-RISK-BIOLOGY
PCWG3-defined PSA progression on systemic prostate-cancer therapy: ≥25% rise from nadir + ≥2 ng/mL absolute increase, confirmed by a second value ≥3 weeks later. Triggers re-imaging + MDT consideration of next-line therapy switch — but NOT alone sufficient to change line if radiographic + clinical disease stable (per PCWG3 + STAR criteria). RF-PROSTATE-PSA-PROGRESSION

CONTRA-AGGRESSIVE

Hard contraindications to escalation

Timeline

Treatment timeline — derived from regimen + monitoring schedule

Standard plan

Induction · ADT + enzalutamide (continuous

28-day cycles × Continuous until progression or unacceptable toxicity

Aggressive plan

Induction · Olaparib monotherapy (mCRPC, H

28-day cycles × Continuous until progression

MDT brief

Skills (recommended) — for consideration (1)

Clinical pharmacist recommended
Chemoimmunotherapy regimen — drug-drug interactions, dose adjustments, premedication.
skill: clinical_pharmacistv0.1.0reviewed 2026-04-25STUBsign-offs: 0lead: TBD

Open questions (1, 0 blocking)

OQ-LDH-CURRENT
What is the current LDH? Marker of tumor burden and transformation.
LDH is part of the prognostic indices of indolent lymphomas.
→ hematologist

Data quality

Unevaluated RedFlags: RF-CHAARTED-HIGH-VOLUME-MHSPC, RF-LATITUDE-HIGH-RISK-MHSPC, RF-PAN-ATM-CHEK2-CDK12-PARPI-CANDIDATE, RF-PAN-BRCA-SOMATIC-PARPI-CANDIDATE, RF-PAN-PALB2-PARPI-CANDIDATE, RF-PROSTATE-AR-AMP-ARSI-RESISTANCE, RF-PROSTATE-AR-V7-ARSI-RESISTANCE, RF-PROSTATE-CORD-COMPRESSION, RF-PROSTATE-FRAILTY-AGE, RF-PROSTATE-HIGH-RISK-BIOLOGY, RF-PROSTATE-INFECTION-SCREENING, RF-PROSTATE-ORGAN-DYSFUNCTION, RF-PROSTATE-PSA-PROGRESSION, RF-PROSTATE-TMPRSS2-ERG-PROGNOSTIC, RF-PROSTATE-TRANSFORMATION-PROGRESSION

Skill catalog (1/16 activated in this plan)

All registered virtual specialists. ✓ — activated for this case; ○ — not activated (available for other clinical scenarios).

Specialist	skill_id	Version	Last reviewed	Domain
Cellular therapy specialist (CAR-T)	`cellular_therapy_specialist`	v0.1.0	2026-04-25	cellular_therapy
Clinical pharmacist	`clinical_pharmacist`	v0.1.0	2026-04-25	clinical_pharmacy
Hematologist / oncohematologist	`hematologist`	v0.1.0	2026-04-25	hematology_oncology
Hematopathologist (lymphoma / leukemia / myeloma)	`hematopathologist`	v0.1.0	2026-04-25	hematopathology
Infectious disease / hepatology	`infectious_disease_hepatology`	v0.1.0	2026-04-25	infectious_diseases
Medical oncologist (solid-tumor chemotherapist)	`medical_oncologist`	v0.1.0	2026-04-25	solid_oncology
Molecular geneticist / molecular oncologist	`molecular_geneticist`	v0.1.0	2026-04-25	molecular_oncology
Palliative care	`palliative_care`	v0.1.0	2026-04-25	palliative_care
Pathologist (general)	`pathologist`	v0.1.0	2026-04-25	pathology
Primary care / family physician	`primary_care`	v0.1.0	2026-04-25	primary_care
Psycho-oncologist	`psychologist`	v0.1.0	2026-04-25	psychosocial
Radiation oncologist	`radiation_oncologist`	v0.1.0	2026-04-25	radiation_oncology
Radiologist	`radiologist`	v0.1.0	2026-04-25	diagnostic_imaging
Social worker / case manager	`social_worker_case_manager`	v0.1.0	2026-04-25	psychosocial
Surgical oncologist	`surgical_oncologist`	v0.1.0	2026-04-25	surgical_oncology
Transplant specialist (BMT)	`transplant_specialist`	v0.1.0	2026-04-25	cellular_therapy

Sources cited

SRC-ESMO-PROSTATE-2024: ESMO Clinical Practice Guideline on Prostate Cancer (2024)
SRC-NCCN-PROSTATE-2025: NCCN Clinical Practice Guidelines — Prostate Cancer (2025.v3)

Experimental options (clinical trials)

Third plan track — open-enrollment trials from ClinicalTrials.gov. Render-time metadata; engine selection is not affected by this block (CHARTER §8.3). Last synced: 2026-05-04.

NCT	Title	Phase	Status	Sponsor	UA
NCT06844383	A Study of Talazoparib With or Without Enzalutamide in People With Prostate Cancer Who Have Previously Received Abiraterone Acetate	PHASE2	RECRUITING	Prostate Cancer Clinical Trials Consortium	—
NCT06724159	Observational Study of the Effectiveness of Funded Drugs for Genitourinary Tumors.	N/A	RECRUITING	Spanish Oncology Genito-Urinary Group	—
NCT07523529	Biomarker-Guided Dual-Target CAR-T Cells for Advanced Solid Tumors	PHASE1 / PHASE2	RECRUITING	Beijing Biotech	—
NCT05691465	Testing the Safety and Effectiveness of Radiation-based Treatment (Lutetium Lu 177 Dotatate) for Metastatic Prostate Cancer That Has Neuroendocrine Cells	PHASE2	RECRUITING	National Cancer Institute (NCI)	—
NCT04485013	TTX-080 HLA-G Antagonist in Subjects With Advanced Cancers	PHASE1	RECRUITING	Tizona Therapeutics, Inc	—
NCT06931340	Testing the Addition of Docetaxel (Chemotherapy) to the Usual Treatment (Hormonal Therapy and Apalutamide) for Metastatic Prostate Cancer, ASPIRE Trial	PHASE3	RECRUITING	Alliance for Clinical Trials in Oncology	—
NCT05610852	Single-Port Transvesical Partial Prostatectomy Versus High Intensity Focused Ultrasound	NA	RECRUITING	Case Comprehensive Cancer Center	—
NCT05463796	InAdvance: Surveillance, Prevention, and Interception in a Population at Risk for Cancer	N/A	RECRUITING	Dana-Farber Cancer Institute	—
NCT06926374	Prospective Evaluation of Cornerstone Robotics Sentire Surgical System in Major Gastrointestinal and Urologic Surgery	NA	RECRUITING	Chinese University of Hong Kong	—
NCT06200259	Reduction of Gastrointestinal Toxicity in Prostate Cancer by Proton Spot Placement	NA	RECRUITING	Covenant Health Cancer Center	—

Verify recruitment status directly with the trial site. ctgov data can lag behind current UA-site status.

Option availability in Ukraine

Per-track UA registration · NSZU · cost · access pathway. Render-time metadata; engine selection does not depend on these fields (CHARTER §8.3).

Option	UA registration	NSZU	Cost orientation	Access pathway
Standard plan ADT + enzalutamide (continuous) (REG-ADT-ENZALUTAMIDE)	✓ registered	✓ covered	₴-? — verify pathway	NSZU formulary
Aggressive plan Olaparib monotherapy (mCRPC, HRR-mutant) (REG-OLAPARIB-MONO)	✓ registered	✓ covered	₴-? — verify pathway	NSZU formulary
IND-PROSTATE-MCRPC-2L-LU-PSMA — No regimen components on this track — availability unknown	— unknown	— unknown	₴-? — verify pathway	not recorded
Trial · NCT06844383 A Study of Talazoparib With or Without Enzalutamide in People With Prostate Cancer Who Have Previously Received Abiraterone Acetate No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT06724159 Observational Study of the Effectiveness of Funded Drugs for Genitourinary Tumors. No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT07523529 Biomarker-Guided Dual-Target CAR-T Cells for Advanced Solid Tumors No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT05691465 Testing the Safety and Effectiveness of Radiation-based Treatment (Lutetium Lu 177 Dotatate) for Metastatic Prostate Cancer That Has Neuroendocrine Cells No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT04485013 TTX-080 HLA-G Antagonist in Subjects With Advanced Cancers No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT06931340 Testing the Addition of Docetaxel (Chemotherapy) to the Usual Treatment (Hormonal Therapy and Apalutamide) for Metastatic Prostate Cancer, ASPIRE Trial No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT05610852 Single-Port Transvesical Partial Prostatectomy Versus High Intensity Focused Ultrasound No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT05463796 InAdvance: Surveillance, Prevention, and Interception in a Population at Risk for Cancer No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT06926374 Prospective Evaluation of Cornerstone Robotics Sentire Surgical System in Major Gastrointestinal and Urologic Surgery No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT06200259 Reduction of Gastrointestinal Toxicity in Prostate Cancer by Proton Spot Placement No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor

Cost information is orientation. Verify with a specific pharmacy / foundation / trial site. Status updated: 2026-05-04.

plan_id: PLAN-BMA-MLH1_GERMLINE_PROSTATE-V1 | version: 1 | generated: 2026-05-04T14:13:16.628790+00:00

Per FDA non-device CDS positioning (CHARTER §15): Outpatient oncology treatment planning to support tumor-board discussion. Not a medical device; not for autonomous clinical decision-making.

Per FDA non-device CDS positioning (CHARTER §15): Both treatment options below are presented for review. The engine's selection of a 'recommended' default does not constitute a clinical decision. Final treatment selection requires HCP judgment incorporating information not available to the system.

This document is an informational resource supporting tumor-board discussion (per CHARTER §11). It is not a system that makes clinical decisions. Every recommendation must be verified by the treating physician.