Advances in the treatment of metastatic prostate cancer

The field of metastatic prostate cancer (mPCa) has seen unprecedented therapeutic advances in the past decade. In the past 2 years, recent approvals include the triplet therapy regimens of androgen deprivation therapy (ADT), docetaxel, and an androgen receptor (AR) pathway inhibitor (ARPI) in the castration-sensitive setting and lutetium-177 vipivotide tetraxetan (¹⁷⁷Lu-PSMA-617) and the combination of poly(ADP) ribose polymerase (PARP) inhibitors (PARPis) and ARPIs in the castration-resistant setting. With many agents currently undergoing investigation in registration trials, the therapeutic armamentarium will expand rapidly, making treatment selection and sequencing challenging. Herein, we review the landmark clinical trials ongoing or reported in the past 2 years, discuss the optimal approach to treatment selection, and provide insight into future directions.