OpenOnco · Treatment Plan

Treatment plan — Prostate adenocarcinoma

PLAN-VAR-PROSTATE-FRAIL-V1 · v1 · 2026-06-27

Patient

VAR-PROSTATE-FRAIL · Algorithm: ALGO-PROSTATE-MCRPC-1L

DiagnosisProstate adenocarcinoma

MOH / ICD-10C61

ICD-O-38140/3; C61.9

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-GLEASON-ISUP	BIO definition in KB; no ESCAT BMA entry — verify with clinician

Primary current-line option

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

Primary current-line option selected by ALGO-PROSTATE-MCRPC-1L at step 4.

Other current-line alternatives (1 tracks)

Same treatment line; review when biomarker, access, contraindication, or patient-context assumptions change.

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

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-PSA-SERUM	Serum PSA	Critical	—	—	all tracks
TEST-BONE-SCAN	Whole-body Tc-99m MDP bone scintigraphy	Standard	—	—	all tracks
TEST-GERMLINE-BRCA-PANEL	Germline BRCA1/2 + HRR panel sequencing	Standard	—	CSD Lab: M089	all tracks
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	—	—	all tracks

Red flags — PRO / CONTRA aggressive

PRO-AGGRESSIVE

Triggers that push toward the aggressive track

AR (androgen receptor) gene amplification detected on tumor or ctDNA NGS in mCRPC — INFORMATIONAL signal of mechanistic ARSI resistance. AR amplification is one of the most common acquired resistance mechanisms to abiraterone / enzalutamide / apalutamide / darolutamide; detected in ~30-50% of post-ARSI mCRPC ctDNA samples. AR-amp argues against ARSI-after-ARSI sequencing (limited cross-class benefit) and for early switch to taxane chemotherapy (docetaxel, cabazitaxel) or radioligand 177Lu-PSMA-617 (if PSMA-PET-positive). FDA has NOT approved any therapy decision keyed on AR-amp status — surfaces in MDT brief to flag patients in whom further ARSI escalation is unlikely to add benefit. Companion to RF-PROSTATE-AR-V7-ARSI-RESISTANCE (AR-V7 splice variant); both detect distinct facets of AR-driven resistance. RF-PROSTATE-AR-AMP-ARSI-RESISTANCE
AR-V7 (androgen receptor splice variant 7) detected in CTCs / ctDNA in mCRPC — predictive marker of ARSI (abiraterone, enzalutamide, apalutamide, darolutamide) failure. PROPHECY (Antonarakis 2019): AR-V7-positive on Epic CTC IHC associated with HR ~3 for inferior PFS/OS on ARSI vs AR-V7-negative; switch to taxane (docetaxel, cabazitaxel) recovers responses. INFORMATIONAL — FDA has NOT approved any therapy decision keyed on AR-V7; surfaces in MDT brief to flag patients in whom ARSI-after-ARSI is unlikely to work. RF-PROSTATE-AR-V7-ARSI-RESISTANCE
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 MESCCRF-PROSTATE-CORD-COMPRESSION
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
Renal dysfunction (CrCl <50 mL/min) or severe hepatic impairment (Child-Pugh C) — limits PARPi (olaparib renal-cleared) and ARPI (abiraterone hepatic) dosing.RF-PROSTATE-ORGAN-DYSFUNCTION
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
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.RF-PROSTATE-TRANSFORMATION-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, HRR-mutant)

28-day cycles × Continuous until progression

MDT brief

Discussion questions (3, 1 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-PSA
What is the status of Prostate-specific antigen (PSA) (BIO-PSA)? It is required by track(s): IND-PROSTATE-MCRPC-1L-ARPI, IND-PROSTATE-MCRPC-1L-PARPI. Expected value: PSA baseline + on-treatment per PCWG3 — mandatory response/progression marker; reportable across all systemic prostate indications.
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-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-1L-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

MDT talk tree (5 steps)

#	Owner	Topic	Action
1	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-1L-ARPI, IND-PROSTATE-MCRPC-1L-PARPI. Expected value: PSA baseline + on-treatment per PCWG3 — mandatory response/progression marker; reportable across all systemic prostate indications.
2	hematologist	Staging / disease burden	What is the current LDH? Marker of tumor burden and transformation.
3	molecular_geneticist	Biomarker status	What is the status of Homologous recombination repair (HRR) gene panel status (BIO-HRR-PANEL)? It is required by track(s): IND-PROSTATE-MCRPC-1L-PARPI. Expected value: positive.
4	clinical_pharmacist	Specialist review	Chemoimmunotherapy regimen — drug-drug interactions, dose adjustments, premedication.
5	palliative_care	Specialist review	Reduced performance status / decompensated comorbidity — goals-of-care assessment needed.

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
Palliative care recommended
Reduced performance status / decompensated comorbidity — goals-of-care assessment needed.

Data quality

Incomplete for default-track review. Default-track review is incomplete until required biomarker gaps are resolved.

Biomarker coverage: 1/3 known (33%), 2 missing, 1 default-track gaps
Unevaluated RedFlags: RF-BRCA-CONFIRMED-CARRIER, RF-BRCA-HBOC-FAMILY-HISTORY-SUSPICION, RF-CHAARTED-HIGH-VOLUME-MHSPC, 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-PSA`	Prostate-specific antigen (PSA)	medical_oncologist	yes	IND-PROSTATE-MCRPC-1L-ARPI, IND-PROSTATE-MCRPC-1L-PARPI	Verify result, method, specimen, and report date before sign-off. Expected/constraint: PSA baseline + on-treatment per PCWG3 — mandatory response/progression marker; reportable across all systemic prostate indications
`BIO-HRR-PANEL`	Homologous recombination repair (HRR) gene panel status	molecular_geneticist	no	IND-PROSTATE-MCRPC-1L-PARPI	Verify result, method, specimen, and report date before sign-off. Expected/constraint: positive

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	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: 2026-06-27.

NCT	Title	Phase	Status	Sponsor	UA	Signals
NCT06995053	Computed Tomography-Guided Stereotactic Body Radiation Therapy With Intrafraction Motion Monitoring for the Treatment of Localized Prostate Cancer, ILLUSION Trial	NA	RECRUITING	Jonsson Comprehensive Cancer Center	—	Single country
NCT06616597	Trial Targeting Gut Bacterial Androgen Production to Reverse Therapeutic Resistance to Abiraterone in Patients With Metastatic Prostate Cancer	PHASE2	RECRUITING	Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins	—	Single country
NCT05806515	Carboplatin Chemotherapy Before Surgery for People With High-Risk Prostate Cancer and an Inherited BRCA1 or BRCA2 Gene Mutation	PHASE2	RECRUITING	SWOG Cancer Research Network	—	Small N (<50) Single country
NCT04945642	High Dose-Rate Brachytherapy and Stereotactic Body Radiotherapy for the Treatment of Prostate Adenocarcinoma	NA	RECRUITING	Jonsson Comprehensive Cancer Center	—	Single country
NCT07115914	PSMA PET for Surveillance After Focal Therapy	NA	RECRUITING	University of Chicago	—	Single country
NCT06582628	Talazoparib Plus Enzalutamide After Progression to Abiraterone in Metastatic Prostate Cancer: (TEAM PC)	PHASE2	RECRUITING	Fundacion Oncosur	—	Surrogate endpoint only Single country
NCT04485013	TTX-080 HLA-G Antagonist in Subjects With Advanced Cancers	PHASE1	RECRUITING	Tizona Therapeutics, Inc	—	Phase 1 only Surrogate endpoint only Single country
NCT07196488	Dyadic Co-learning Intervention for Patients With Prostate Cancer and Their Spouses	NA	RECRUITING	National Taipei University of Nursing and Health Sciences	—	Single country
NCT06862856	Flotufolastat F 18 PET in Men With Very Low PSA Recurrence	N/A	RECRUITING	Massachusetts General Hospital	—	Single country
NCT04373564	Effect on Body Movement and Mental Skills in Patients Who Received Gadolinium-based Contrast Media for Magnetic Resonance Examination Multiple Times Within 5 Years	PHASE4	RECRUITING	Guerbet	—	—

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
Trial · NCT06995053 Computed Tomography-Guided Stereotactic Body Radiation Therapy With Intrafraction Motion Monitoring for the Treatment of Localized Prostate Cancer, ILLUSION Trial No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT06616597 Trial Targeting Gut Bacterial Androgen Production to Reverse Therapeutic Resistance to Abiraterone in Patients With Metastatic Prostate Cancer No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT05806515 Carboplatin Chemotherapy Before Surgery for People With High-Risk Prostate Cancer and an Inherited BRCA1 or BRCA2 Gene Mutation No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT04945642 High Dose-Rate Brachytherapy and Stereotactic Body Radiotherapy for the Treatment of Prostate Adenocarcinoma No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT07115914 PSMA PET for Surveillance After Focal Therapy No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT06582628 Talazoparib Plus Enzalutamide After Progression to Abiraterone in Metastatic Prostate Cancer: (TEAM PC) 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 · NCT07196488 Dyadic Co-learning Intervention for Patients With Prostate Cancer and Their Spouses No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT06862856 Flotufolastat F 18 PET in Men With Very Low PSA Recurrence No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT04373564 Effect on Body Movement and Mental Skills in Patients Who Received Gadolinium-based Contrast Media for Magnetic Resonance Examination Multiple Times Within 5 Years 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: 2026-06-27.

plan_id: PLAN-VAR-PROSTATE-FRAIL-V1 | version: 1 | generated: 2026-06-27T09:41:02.213566+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.