• Nephrectomy
• First Line (good prognosis): Sunitinib/Pazopanib
• First Line (intermediate- or poor-risk): Nivolumab + Ipilimumab
• Second Line: Nivolumab OR Sunitinib/Pazopanib

Surgical resection & radiotherapy

Frequently responds to treatment, even when widespread

5 year relative survival 84%

Increased PSA may precede clinical disease by 5-10 years

Androgen deprivation therapy

ChemoHormonal therapy upfront - standard of care in high volume disease (4 or more bone met sites and/or visceral disease)

• First Line: GnRH agonists +/- Docetaxel (if high volume)
• Second Line: GnRH agonists, testosterone antagonists
• Third Line: Androgen withdrawal/GnRH agonist alone

1. Stage 1: Surgery
2. Stage 2: Surgery or radiotherapy (if not fit for surgery)

• Non-bulky Stage 3A: Surgery +/- RTx + neoadjuvant chemotherapy
  • Durvalumab

• Immunotherapy - option depends on driver mutation, PDL-1, squamous vs adeno, ECOG (<2), CNS mets (poor prognosis)

• Pembrolizumab

• Double platinum based chemotherapy
  • Single agent if elderly
  • Best supportive care if poor ECOG

• Alectinib - preferred 1st line due to CNS penetration

Other options: Crizotinib (1st gen, S/E, poor CNS)

Ceritinib: 2nd line if progression after crizotinib

ALK only present in 4-5% of adenocarcinoma

• Surgery
• Single agent chemotherapy for high risk patients
  • 5-FU or
  • Capecitabine

EGFR Inhibitor

• Cetuximab
• Panitumumab

VEGF inhibitor

• Bevacizumab