Systemic therapy in metastatic hormone-sensitive prostate cancer

Area of Science:

• Oncology
• Urology

Background:

• Metastatic hormone-sensitive prostate cancer (mHSPC) treatment has evolved with new data supporting upfront intensification.
• Recent trials demonstrate survival benefits from combining systemic agents and local therapies.

Approach:

• Review of landmark trials (ARASENS, PEACE) evaluating treatment intensification strategies.
• Analysis of data on systemic agents (chemotherapy, androgen receptor pathway inhibitors) and local therapies (primary tumor, metastases).

Key Points:

• Combination therapy (docetaxel, abiraterone, darolutamide) with androgen deprivation therapy (ADT) shows survival benefit.
• Local therapy to primary tumor and metastases shows promise for improved survival and recurrence-free survival.
• Disease volume (high vs. low) is critical for tailoring mHSPC treatment, but definitions are evolving.

Conclusions:

• Treatment intensification is the new standard of care for mHSPC, supported by robust clinical data.
• Personalized treatment strategies considering disease volume are essential.
• Ongoing research and advanced imaging are needed to refine disease volume assessment.