Synthetic educational example. Do not self-treat: a qualified treating physician must verify the sources, patient data, contraindications, and final plan.
Patient
SHOWCASE-PROSTATE-BRCA2-001 · Algorithm: ALGO-PROSTATE-MCRPC-2L
Clinical significance of mutations (ESCAT)
Tumor-board context — the engine does not use these tiers to rank tracks
| Biomarker | Variant | ESCAT | Evidence | Clinical significance | Drugs | Sources |
|---|
| ESCAT: clinical review pendingBIO-BRCA1-BRCA2-GERMLINE | BRCA2 germline pathogenic | IA | Molecular evidence option - SRC-CIVIC: Level A (Supports, Sensitivity/Response)
- SRC-CIVIC: Level B (Supports, Better Outcome)
Resistance or avoidance signal Trial or research option - SRC-CIVIC: Level C (Supports, Sensitivity/Response)
| BRCA2 germline pathogenic in mCRPC: largest PARPi benefit in HRR pathway (PROfound Cohort A); olaparib post-NHA, 1L olaparib+abiraterone (PROpel), niraparib+abiraterone (MAGNITUDE), talazoparib+enzalutamide (TALAPRO-2) all approved. ESCAT IA / OncoKB Level 1. | olaparib monotherapy (post-NHA)
olaparib + abiraterone (1L)
niraparib + abiraterone (1L)
talazoparib + enzalutamide (1L)
rucaparib monotherapy | - SRC-NCCN-PROSTATE-2025
- SRC-ESMO-PROSTATE-2024
- SRC-EAU-PROSTATE-2024
|
| Biomarker | Status |
|---|
| MSI | Not in KB — ask clinician to verify |
| PSMA PET | Not in KB — ask clinician to verify |
Primary current-line option
- Indication
- IND-PROSTATE-MCRPC-2L-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
- Primary current-line option selected by ALGO-PROSTATE-MCRPC-2L at step 2.
Other current-line alternatives (4 tracks)
Same treatment line; review when biomarker, access, contraindication, or patient-context assumptions change.
- Indication
- IND-PROSTATE-MCRPC-2L-LU-PSMA
- Regimen
- Lutetium-177 PSMA-617 radioligand therapy
- Drugs + NSZU
- Lutetium-177 PSMA-617 (DRUG-LUTETIUM-177-PSMA) 7.4 GBq IV · q6 weeks × 6 cycles · IV ✗ Not registered in UA
- Supportive care
- SUP-BONE-HEALTH-PROSTATE
- Reason
- Current-line alternative presented for HCP consideration
- Indication
- IND-PROSTATE-MCRPC-2L-CABAZITAXEL
- Regimen
- Cabazitaxel (mCRPC, 2L)
- Drugs + NSZU
- Cabazitaxel (DRUG-CABAZITAXEL) 20-25 mg/m² IV over 60 min · Day 1 q21d · IV ✗ Not registered in UA
- Prednisone (DRUG-PREDNISONE) 10 mg PO daily (continuous, throughout cabazitaxel treatment) · Daily · PO ⚠ NSZU — not for this indication
- Reason
- Current-line alternative presented for HCP consideration
- Indication
- IND-PROSTATE-MCRPC-2L-RADIUM223
- Regimen
- Radium-223 (mCRPC, bone-metastatic)
- Drugs + NSZU
- Radium-223 dichloride (DRUG-RADIUM-223) 55 kBq/kg IV (body weight-based) over 1 min · Once every 4 weeks × 6 injections (total course = 6 months) · IV ⚠ Out-of-pocket
- Reason
- Current-line alternative presented for HCP consideration
- Indication
- IND-PROSTATE-MCRPC-2L-DOCETAXEL
- Regimen
- Docetaxel (mCRPC)
- Drugs + NSZU
- Docetaxel (DRUG-DOCETAXEL) 75 mg/m² IV over 60 min · Day 1 q21d · IV ✓ NSZU covered
- Prednisone (DRUG-PREDNISONE) 10 mg PO daily (continuous) · Daily throughout docetaxel course · PO ⚠ NSZU — not for this indication
- Reason
- Current-line alternative 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-CBC | Complete Blood Count with Differential | Critical | lab | — | standard |
| TEST-CMP | Comprehensive Metabolic Panel | Critical | lab | — | standard |
| TEST-LFT | Liver Function Tests (ALT, AST, bilirubin, ALP, GGT, albumin) | Critical | lab | — | standard |
| TEST-PSA-SERUM | Serum PSA | Critical | — | — | all tracks |
| TEST-BONE-SCAN | Whole-body Tc-99m MDP bone scintigraphy | Standard | — | — | aggressive |
| TEST-ECG | Electrocardiogram | Standard | clinical_assessment | — | standard |
| TEST-GERMLINE-BRCA-PANEL | Germline BRCA1/2 + HRR panel sequencing | Standard | — | CSD Lab: M089 | aggressive |
| TEST-PSMA-PET | PSMA-PET/CT (Ga-68 or F-18) | Standard | — | — | 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 |
Red flags — PRO / CONTRA aggressive
PRO-AGGRESSIVE
Triggers that push toward the aggressive track
- Germline pathogenic variant in ATM, CHEK2, or CDK12 (composite HRR-pathway RF). Disease-specific evidence varies sharply: ATM contributes to PROfound cohort-A (mCRPC) — pooled with BRCA1/2 for olaparib mPFS 7.4 vs 3.6 mo (HR 0.34). CDK12 — strong prostate-specific actionability (cohort-B in PROfound; immune-hot phenotype with elevated tumor neoantigens — emerging immunotherapy / PARPi rationale). CHEK2 — moderate-penetrance breast/prostate risk gene; weakest PARPi-response evidence (cohort-B in PROfound, smaller absolute benefit). Pan-tumor framing: treatment-modifying primarily in mCRPC; informational MDT signal in breast / pancreatic / ovarian where label-grade evidence is absent.
Composite RF references BIO-ATM-CHEK2-CDK12-GERMLINE. Distinct from RF-PROSTATE-HIGH-RISK-BIOLOGY (which keys on broad hrr_pathway_mutation flag) — this RF surfaces gene-specific findings for nuanced MDT discussion. Algorithm wiring…
RF-PAN-ATM-CHEK2-CDK12-PARPI-CANDIDATESRC-PROFOUND-DEBONO-2020SRC-NCCN-PROSTATE-2025SRC-NCCN-BREAST-2025 - Somatic (tumor-only) BRCA1 or BRCA2 pathogenic variant identified on tumor NGS — pan-tumor PARPi-candidate signal. Disease applicability varies: ovarian (PAOLA-1, SOLO-1 — somatic BRCA pooled with germline in HRD-positive maintenance indication), mCRPC (PROfound cohort-A — olaparib mPFS 7.4 vs 3.6 mo, HR 0.34, somatic + germline pooled), pancreatic PDAC (POLO label is germline-only — somatic BRCA falls to off-label / NCCN "consider" tier), breast (OlympiAD / EMBRACA / OlympiA labels are germline-only — somatic BRCA breast remains investigational). Confirm somatic vs germline status via paired germline NGS before cascade-testing decisions (~40% of tumor-only "BRCA" calls are in fact germline per ASCO/CAP guidance).
Distinct trigger keys from RF-OVARIAN-BRCA-MUT-ACTIONABLE and RF-PROSTATE-HIGH-RISK-BIOLOGY to avoid double-firing on germline cases — this RF keys specifically on "*_somatic" / "tumor_*" findings. Breast included as informational (no…
RF-PAN-BRCA-SOMATIC-PARPI-CANDIDATESRC-PROFOUND-DEBONO-2020SRC-NCCN-OVARIAN-2025SRC-NCCN-PROSTATE-2025 - Germline PALB2 pathogenic variant — BRCA2's recruitment partner; biallelic LOF produces an HRR-deficient phenotype. Pan-tumor PARPi candidate signal weaker than gBRCA1/2 but emerging. Disease applicability: breast (lifetime risk ~35-55%, NCCN high-penetrance — PARPi off-label / investigational), PDAC (~3-5x baseline risk, POLO label is gBRCA-only but PALB2 frequently grouped clinically), prostate mCRPC (cohort-B in PROfound HRR-non-BRCA/ATM — smaller absolute olaparib benefit but PARPi remains an option per NCCN 2025). Genetic counseling + cascade testing of first-degree relatives required.
References BIO-PALB2-GERMLINE. Surveillance recommendations: enhanced breast screening (annual MRI from age 30), pancreatic surveillance per CAPS consortium when family history present. RF distinct from RF-BREAST-BRCA-GERMLINE-ACTIONABLE…
RF-PAN-PALB2-PARPI-CANDIDATESRC-PROFOUND-DEBONO-2020SRC-NCCN-BREAST-2025SRC-NCCN-PANCREATIC-2025 - Metastatic prostate cancer with malignant epidural spinal cord compression (MESCC): new motor deficit, sensory level, cauda equina syndrome, severe back pain with vertebral metastasis — prostate is the most common solid tumor cause of MESCC
Per NCCN-PROSTATE supportive-care + EAU-PROSTATE 2024: dexamethasone 10 mg IV bolus + 4 mg q6h, MRI whole spine within 24 h, multidisciplinary surgical/RT review. Patchell criteria for surgery (single-level, ≥48 h expected survival…
RF-PROSTATE-CORD-COMPRESSIONSRC-NCCN-PROSTATE-2025SRC-ESMO-PROSTATE-2024SRC-EAU-PROSTATE-2024 - Pre-treatment HBV/HCV/HIV serology + dental evaluation (denosumab/zoledronate ONJ risk; lutetium-PSMA xerostomia) standard for mCRPC initiation.
Cross-disease HBV reactivation handled by RF-UNIVERSAL-HBV-REACTIVATION- RISK. Dental clearance pre-bone-modifying-agent unique to bone-meta diseases (prostate, breast, MM).
RF-PROSTATE-INFECTION-SCREENINGSRC-NCCN-PROSTATE-2025SRC-ESMO-PROSTATE-2024 - Renal dysfunction (CrCl <50 mL/min) or severe hepatic impairment (Child-Pugh C) — limits PARPi (olaparib renal-cleared) and ARPI (abiraterone hepatic) dosing.
Olaparib requires CrCl ≥31 (with dose-mod) for safe use; <30 avoid. Abiraterone Child-Pugh C: avoid. Surfaces in MDT as need for renal/ hepatic input.
RF-PROSTATE-ORGAN-DYSFUNCTIONSRC-NCCN-PROSTATE-2025SRC-ESMO-PROSTATE-2024 - Spinal cord compression OR rapid PSA doubling time (<3 months) OR new visceral metastases — emergency or aggressive-progression flag requiring urgent intervention or treatment intensification.
Spinal cord compression: emergent neurosurgical / RT consult AND immediate testosterone suppression (degarelix preferred for speed vs LHRH agonists). PSA doubling time <3 months in nmCRPC: criterion for ARPI initiation per NCCN. Visceral…
RF-PROSTATE-TRANSFORMATION-PROGRESSIONSRC-NCCN-PROSTATE-2025SRC-ESMO-PROSTATE-2024
CONTRA-AGGRESSIVE
Hard contraindications to escalation
What NOT to do
Explicit prohibitive rules, each grounded in a regimen / supportive care / contraindication entity
Standard plan (IND-PROSTATE-MCRPC-2L-LU-PSMA)
- НІКОЛИ не призначати без PSMA-ПЕТ/КТ-підтвердження — тільки PSMA-позитивна хвороба
- Не призначати при будь-якому PSMA-негативному осередку метастазування
- Не ігнорувати ниркову функцію — лютецій виводиться нирками; ГФК <30 = протипоказання
- Не пропускати тестування HRR/BRCA до призначення — PARPi перевершує при BRCA1/2
- Не призначати без підтримки ядерно-медичного відділу з радіотерапевтичною ліцензією
Standard plan (IND-PROSTATE-MCRPC-2L-CABAZITAXEL)
- Не призначати другий АРПІ (ензалутамід або абіратерон) при прогресуванno після доцеyesселю + попереднього АРПІ — CARD показав значно нижчу ефективnoсть (ORR 12% vs 35%)
- Не застосовувати без G-CSF первинної профілактики — ризик нейтропеnoчної гарячки
- Не призначати при важкій печінковій недостатності (білірубін >3 × ВМН)
- Не пропускати тестування HRR/BRCA — PARPi перевершує хіміотерапію при BRCA1/2-мутованих пацієнтах
Standard plan (IND-PROSTATE-MCRPC-2L-RADIUM223)
- НІКОЛИ не призначати при вісцеральних метастазах — тільки при кістковому захворюванno
- НІКОЛИ не комбінувати з абіратероном/ензалутамідом (ERA 223: підвищений ризик переломів та смертності)
- НІКОЛИ не комбінувати з доцеyesселем (ALSYMPCA+: підвищена токсичnoсть без переваги)
- Не призначати без КТ-підтвердження відсутності вісцеральних метастазів перед кожною ін'єкцією
- Не ігнорувати радіаційну безпеку — пацієнт залишається джерелом радіації 7-10 дnoв після ін'єкції
Standard plan (IND-PROSTATE-MCRPC-2L-DOCETAXEL)
- Не призначати доцеyesсел при попередньому yesсаno (доцеyesсел або кабазиyesсел) — використовувати кабазиyesсел (CARD: OS HR 0.64 vs другий АРПІ)
- Не пропускати тестування HRR/BRCA — PARPi перевершує хіміотерапію при BRCA1/2-мутованих пацієнтах
- Не припиняти АДТ (ГДТ) під час хіміотерапії — кастраційний рівень тестостерону підтримується протягом усього лікування
- Не призначати при важкій печінковій недостатності (білірубін >3 × ВМН)
- Не забути 3-денний дексаметазон преmedication (8 мг двічі/добу) — профілактика затримки рідини та гіперчутливості
Timeline
Treatment timeline — derived from regimen + monitoring schedule
Aggressive plan
Induction · Olaparib monotherapy (mCRPC, HRR-mutant)
28-day cycles × Continuous until progression
Standard plan
Induction · Lutetium-177 PSMA-617 radioligand therapy
42-day cycles × 6 (extend to 8 if responding and tolerated, per protocol)
Standard plan
Induction · Cabazitaxel (mCRPC, 2L)
21-day cycles × Continue until progression or unacceptable toxicity; typically 6-10 cycles
Standard plan
Induction · Radium-223 (mCRPC, bone-metastatic)
28-day cycles × 6
Standard plan
Induction · Docetaxel (mCRPC)
21-day cycles × 10 cycles (TAX 327 protocol); may continue beyond 10 if responding and tolerating
MDT brief
Discussion questions (5, 3 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
BLOCKING OQ-BIOMARKER-GLEASON-ISUP
What is the status of Gleason score / ISUP grade group (BIO-GLEASON-ISUP)? It is required by track(s): IND-PROSTATE-MCRPC-2L-PARPI, IND-PROSTATE-MCRPC-2L-LU-PSMA, IND-PROSTATE-MCRPC-2L-CABAZITAXEL, IND-PROSTATE-MCRPC-2L-RADIUM223, IND-PROSTATE-MCRPC-2L-DOCETAXEL. Expected value: Gleason / ISUP grade group (1-5).
A treatment-track biomarker requirement is missing from the patient profile; the MDT should verify the test result, method, specimen, and date before relying on this option.
→ medical_oncologist
BLOCKING OQ-BIOMARKER-HRR-PANEL
What is the status of Homologous recombination repair (HRR) gene panel status (BIO-HRR-PANEL)? It is required by track(s): IND-PROSTATE-MCRPC-2L-PARPI. Expected value: positive.
A treatment-track biomarker requirement is missing from the patient profile; the MDT should verify the test result, method, specimen, and date before relying on this option.
→ molecular_geneticist
BLOCKING OQ-BIOMARKER-PSA
What is the status of Prostate-specific antigen (PSA) (BIO-PSA)? It is required by track(s): IND-PROSTATE-MCRPC-2L-PARPI, IND-PROSTATE-MCRPC-2L-LU-PSMA, IND-PROSTATE-MCRPC-2L-CABAZITAXEL, IND-PROSTATE-MCRPC-2L-RADIUM223, IND-PROSTATE-MCRPC-2L-DOCETAXEL. Expected value: PSA baseline + on-treatment per PCWG3.
A treatment-track biomarker requirement is missing from the patient profile; the MDT should verify the test result, method, specimen, and date before relying on this option.
→ medical_oncologist
OQ-BIOMARKER-PSMA-PET
What is the status of PSMA-PET imaging avidity (BIO-PSMA-PET)? It is required by track(s): IND-PROSTATE-MCRPC-2L-LU-PSMA. Expected value: PSMA-PET/CT POSITIVE — MANDATORY (68Ga-PSMA-11 or 18F-DCFPyL preferred).
A treatment-track biomarker requirement is missing from the patient profile; the MDT should verify the test result, method, specimen, and date before relying on this option.
→ medical_oncologist
MDT talk tree (7 steps)
| # | Owner | Topic | Action |
|---|
| 1 | medical_oncologist | Biomarker status BLOCKING | What is the status of Gleason score / ISUP grade group (BIO-GLEASON-ISUP)? It is required by track(s): IND-PROSTATE-MCRPC-2L-PARPI, IND-PROSTATE-MCRPC-2L-LU-PSMA, IND-PROSTATE-MCRPC-2L-CABAZITAXEL, IND-PROSTATE-MCRPC-2L-RADIUM223, IND-PROSTATE-MCRPC-2L-DOCETAXEL. Expected value: Gleason / ISUP grade group (1-5). |
| 2 | medical_oncologist | Biomarker status BLOCKING | What is the status of Prostate-specific antigen (PSA) (BIO-PSA)? It is required by track(s): IND-PROSTATE-MCRPC-2L-PARPI, IND-PROSTATE-MCRPC-2L-LU-PSMA, IND-PROSTATE-MCRPC-2L-CABAZITAXEL, IND-PROSTATE-MCRPC-2L-RADIUM223, IND-PROSTATE-MCRPC-2L-DOCETAXEL. Expected value: PSA baseline + on-treatment per PCWG3. |
| 3 | molecular_geneticist | Biomarker status BLOCKING | What is the status of Homologous recombination repair (HRR) gene panel status (BIO-HRR-PANEL)? It is required by track(s): IND-PROSTATE-MCRPC-2L-PARPI. Expected value: positive. |
| 4 | hematologist | Staging / disease burden | What is the current LDH? Marker of tumor burden and transformation. |
| 5 | medical_oncologist | Biomarker status | What is the status of PSMA-PET imaging avidity (BIO-PSMA-PET)? It is required by track(s): IND-PROSTATE-MCRPC-2L-LU-PSMA. Expected value: PSMA-PET/CT POSITIVE — MANDATORY (68Ga-PSMA-11 or 18F-DCFPyL preferred). |
| 6 | clinical_pharmacist | Specialist review | Chemoimmunotherapy regimen — drug-drug interactions, dose adjustments, premedication. |
| 7 | social_worker_case_manager | Specialist review | Plan includes drugs without NSZU reimbursement — patient access pathway must be assessed. |
Skills (recommended) — for consideration (3)
- Clinical pharmacist recommended
Chemoimmunotherapy regimen — drug-drug interactions, dose adjustments, premedication.
- Molecular geneticist / molecular oncologist recommended
Indication references an actionable genomic biomarker — mutation / target / actionability interpretation needed.
Owns: OQ-BIOMARKER-HRR-PANEL
- Social worker / case manager recommended
Plan includes drugs without NSZU reimbursement — patient access pathway must be assessed.
Data quality
Incomplete for default-track review. Default-track review is incomplete until required biomarker gaps are resolved.
- Biomarker coverage: 0/4 known (0%), 4 missing, 3 default-track gaps
- Unevaluated RedFlags: RF-ATM-CONFIRMED-CARRIER, RF-ATM-FAMILY-HISTORY-SUSPICION, RF-BRCA-CONFIRMED-CARRIER, RF-BRCA-HBOC-FAMILY-HISTORY-SUSPICION, RF-CASCADE-BRCA-FDR-POSITIVE, RF-CASCADE-FAP-FDR-POSITIVE, RF-CASCADE-LYNCH-FDR-POSITIVE, RF-CHAARTED-HIGH-VOLUME-MHSPC, RF-CHEK2-CONFIRMED-CARRIER, RF-CHEK2-FAMILY-HISTORY-SUSPICION, RF-FAP-FAMILY-HISTORY-SUSPICION, RF-LATITUDE-HIGH-RISK-MHSPC, RF-LYNCH-CONFIRMED-CARRIER, RF-LYNCH-FAMILY-HISTORY-SUSPICION, 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
| Missing biomarker | Label | MDT owner | Default track | Required by | Next action |
|---|
BIO-GLEASON-ISUP | Gleason score / ISUP grade group | medical_oncologist | yes | IND-PROSTATE-MCRPC-2L-PARPI, IND-PROSTATE-MCRPC-2L-LU-PSMA, IND-PROSTATE-MCRPC-2L-CABAZITAXEL, IND-PROSTATE-MCRPC-2L-RADIUM223, IND-PROSTATE-MCRPC-2L-DOCETAXEL | Verify result, method, specimen, and report date before sign-off. Expected/constraint: Gleason / ISUP grade group (1-5) |
BIO-HRR-PANEL | Homologous recombination repair (HRR) gene panel status | molecular_geneticist | yes | IND-PROSTATE-MCRPC-2L-PARPI | Verify result, method, specimen, and report date before sign-off. Expected/constraint: positive |
BIO-PSA | Prostate-specific antigen (PSA) | medical_oncologist | yes | IND-PROSTATE-MCRPC-2L-PARPI, IND-PROSTATE-MCRPC-2L-LU-PSMA, IND-PROSTATE-MCRPC-2L-CABAZITAXEL, IND-PROSTATE-MCRPC-2L-RADIUM223, IND-PROSTATE-MCRPC-2L-DOCETAXEL | Verify result, method, specimen, and report date before sign-off. Expected/constraint: PSA baseline + on-treatment per PCWG3 |
BIO-PSMA-PET | PSMA-PET imaging avidity | medical_oncologist | no | IND-PROSTATE-MCRPC-2L-LU-PSMA | Verify result, method, specimen, and report date before sign-off. Expected/constraint: PSMA-PET/CT POSITIVE — MANDATORY (68Ga-PSMA-11 or 18F-DCFPyL preferred) |
Technical MDT skill metadata (3/16 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 | Sign-offs | Domain |
|---|
| Cellular therapy specialist (CAR-T) | cellular_therapy_specialist | v0.1.0 | 2026-04-25 | 0 | cellular_therapy |
| Clinical pharmacist | clinical_pharmacist | v0.1.0 | 2026-04-25 | 0 | clinical_pharmacy |
| Hematologist / oncohematologist | hematologist | v0.1.0 | 2026-04-25 | 0 | hematology_oncology |
| Hematopathologist (lymphoma / leukemia / myeloma) | hematopathologist | v0.1.0 | 2026-04-25 | 0 | hematopathology |
| Infectious disease / hepatology | infectious_disease_hepatology | v0.1.0 | 2026-04-25 | 0 | infectious_diseases |
| Medical oncologist (solid-tumor chemotherapist) | medical_oncologist | v0.1.0 | 2026-04-25 | 0 | solid_oncology |
| Molecular geneticist / molecular oncologist | molecular_geneticist | v0.1.0 | 2026-04-25 | 0 | molecular_oncology |
| Palliative care | palliative_care | v0.1.0 | 2026-04-25 | 0 | palliative_care |
| Pathologist (general) | pathologist | v0.1.0 | 2026-04-25 | 0 | pathology |
| Primary care / family physician | primary_care | v0.1.0 | 2026-04-25 | 0 | primary_care |
| Psycho-oncologist | psychologist | v0.1.0 | 2026-04-25 | 0 | psychosocial |
| Radiation oncologist | radiation_oncologist | v0.1.0 | 2026-04-25 | 0 | radiation_oncology |
| Radiologist | radiologist | v0.1.0 | 2026-04-25 | 0 | diagnostic_imaging |
| Social worker / case manager | social_worker_case_manager | v0.1.0 | 2026-04-25 | 0 | psychosocial |
| Surgical oncologist | surgical_oncologist | v0.1.0 | 2026-04-25 | 0 | surgical_oncology |
| Transplant specialist (BMT) | transplant_specialist | v0.1.0 | 2026-04-25 | 0 | cellular_therapy |
Sources cited
- SRC-ALSYMPCA-PARKER-2013: Alpha Emitter Radium-223 and Survival in Metastatic Prostate Cancer
()
- SRC-CARD-DE-BONO-2019: Olaparib for Metastatic Castration-Resistant Prostate Cancer
()
- SRC-ESMO-PROSTATE-2024: ESMO Clinical Practice Guideline on Prostate Cancer (2024)
- SRC-NCCN-PROSTATE-2025: NCCN Clinical Practice Guidelines — Prostate Cancer (2025.v3)
- SRC-TAX327-TANNOCK-2004: Docetaxel plus Prednisone or Mitoxantrone plus Prednisone for Advanced Prostate Cancer ()
- SRC-TROPIC-DE-BONO-2010: Prednisone plus cabazitaxel or mitoxantrone for metastatic castration-resistant prostate cancer progressing after docetaxel treatment: a randomised open-label trial
()
- SRC-VISION-PSMA-SARTOR-2021: Lutetium-177-PSMA-617 for Metastatic Castration-Resistant Prostate Cancer (2021)
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: 2026-08-17.
| NCT | Title | Phase | Status | Sponsor | UA | Signals | Eligibility (excerpt) |
|---|
| NCT07042256 | Feasibility of MR-Informed Adaptive Marker-less SBRT in Patients With Bilateral Hip Prostheses Undergoing SBRT for Localized Prostate Cancer | NA | RECRUITING | — | Small N (<50) Single country | |
| NCT05000294 | Atezolizumab Plus Tivozanib in Immunologically Cold Tumor Types | PHASE1 / PHASE2 | RECRUITING | — | Small N (<50) Surrogate endpoint only Single country | |
| NCT06067269 | Hormone Therapy (Apalutamide) and Image-guided Stereotactic Body Radiation Therapy for the Treatment of Patients With Prostate Cancer, HEATWAVE Trial | PHASE2 | RECRUITING | — | Single country | |
| NCT06369610 | Risk Stratified De-escalated Hormone Therapy With Radiation Therapy for the Treatment of Prostate Cancer | PHASE2 | RECRUITING | — | Single country | |
| NCT07192614 | A Study to Learn How Safe AZD6621 is, How Well it Works, and How it Moves Throughout the Body Over Time, in Adult Male Participants With Metastatic Prostate Cancer | PHASE1 / PHASE2 | RECRUITING | — | Surrogate endpoint only | |
| NCT05022914 | PSMA Guided Approach for bIoCHEmical Relapse After Prostatectomy-PSICHE | N/A | RECRUITING | — | Surrogate endpoint only Single country | |
| NCT07517198 | Dose Determining Study of EXS74539 (REC-4539) in Participants With Select Solid Tumors | PHASE1 | RECRUITING | — | Phase 1 only Small N (<50) Single country | |
| NCT06798558 | Neoadjuvant Lu-177-PSMA-617 in Patients With High Risk Localized Prostate Cancer Undergoing Radical Prostatectomy | PHASE2 | RECRUITING | — | Single country | |
| NCT05109208 | The Use of Ultrasound in Assessing Post-prostatectomy Erectile Dysfunction | NA | RECRUITING | — | Small N (<50) Single country | |
| NCT06683846 | Ivonescimab in the Treatment of Multiple Advanced Tumors | PHASE2 | RECRUITING | — | Surrogate endpoint only Single country | |
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 |
|---|
| Aggressive plan Olaparib monotherapy (mCRPC, HRR-mutant) (REG-OLAPARIB-MONO) | ✓ registered | ✓ covered | ₴-? — verify pathway | NSZU formulary |
| Standard plan Lutetium-177 PSMA-617 radioligand therapy (REG-LUTETIUM-PSMA) 1/1 component drug(s) not registered in Ukraine +1 | ✗ not registered | ✗ out-of-pocket | ₴-? — verify pathway | not recorded |
| Standard plan Cabazitaxel (mCRPC, 2L) (REG-CABAZITAXEL-MCRPC) 1/2 component drug(s) not registered in Ukraine +1 | ✗ not registered | ✗ out-of-pocket | ₴-? — verify pathway | not recorded |
| Standard plan Radium-223 (mCRPC, bone-metastatic) (REG-RADIUM223-MCRPC) 1/1 component drug(s) not on NSZU formulary | ✓ registered | ✗ out-of-pocket | ₴-? — verify pathway | not recorded |
| Standard plan Docetaxel (mCRPC) (REG-DOCETAXEL-MCRPC) | ✓ registered | ✓ covered | ₴-? — verify pathway | NSZU formulary |
| Trial · NCT07042256 Feasibility of MR-Informed Adaptive Marker-less SBRT in Patients With Bilateral Hip Prostheses Undergoing SBRT for Localized Prostate Cancer No UA site listed — international referral required | — unknown | — unknown | self-pay: ₴0/course | Trial sponsor |
| Trial · NCT05000294 Atezolizumab Plus Tivozanib in Immunologically Cold Tumor Types No UA site listed — international referral required | — unknown | — unknown | self-pay: ₴0/course | Trial sponsor |
| Trial · NCT06067269 Hormone Therapy (Apalutamide) and Image-guided Stereotactic Body Radiation Therapy for the Treatment of Patients With Prostate Cancer, HEATWAVE Trial No UA site listed — international referral required | — unknown | — unknown | self-pay: ₴0/course | Trial sponsor |
| Trial · NCT06369610 Risk Stratified De-escalated Hormone Therapy With Radiation Therapy for the Treatment of Prostate Cancer No UA site listed — international referral required | — unknown | — unknown | self-pay: ₴0/course | Trial sponsor |
| Trial · NCT07192614 A Study to Learn How Safe AZD6621 is, How Well it Works, and How it Moves Throughout the Body Over Time, in Adult Male Participants With Metastatic Prostate Cancer No UA site listed — international referral required | — unknown | — unknown | self-pay: ₴0/course | Trial sponsor |
| Trial · NCT05022914 PSMA Guided Approach for bIoCHEmical Relapse After Prostatectomy-PSICHE No UA site listed — international referral required | — unknown | — unknown | self-pay: ₴0/course | Trial sponsor |
| Trial · NCT07517198 Dose Determining Study of EXS74539 (REC-4539) in Participants With Select Solid Tumors No UA site listed — international referral required | — unknown | — unknown | self-pay: ₴0/course | Trial sponsor |
| Trial · NCT06798558 Neoadjuvant Lu-177-PSMA-617 in Patients With High Risk Localized Prostate Cancer Undergoing Radical Prostatectomy No UA site listed — international referral required | — unknown | — unknown | self-pay: ₴0/course | Trial sponsor |
| Trial · NCT05109208 The Use of Ultrasound in Assessing Post-prostatectomy Erectile Dysfunction No UA site listed — international referral required | — unknown | — unknown | self-pay: ₴0/course | Trial sponsor |
| Trial · NCT06683846 Ivonescimab in the Treatment of Multiple Advanced Tumors 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: 2026-08-17.