Advances in Current Treatment Paradigms for Metastatic Hormone-Sensitive Prostate Cancer

Area of Science:

• Oncology
• Urology
• Medical Science

Background:

• Metastatic hormone-sensitive prostate cancer (mHSPCa) requires systemic treatment, with inevitable progression to castration resistance.
• The treatment landscape has evolved, incorporating androgen deprivation therapy (ADT) with androgen receptor signaling inhibitors (ARSIs) or chemotherapy.

Purpose of the Study:

• To review the evolution of mHSPCa treatment strategies.
• To highlight the impact of combination therapies and emerging technologies in managing mHSPCa.

Main Methods:

• Review of landmark clinical trials (CHAARTED, STAMPEDE, LATITUDE, ENZAMET, TITAN, ARASENS, PEACE-1).
• Discussion of advancements in imaging (PSMA PET-CT) and genomic profiling.
• Exploration of ongoing research in novel therapies, targeted agents, and immunotherapies.

Main Results:

• Combination therapies (doublet and triplet) integrating ADT with ARSIs or chemotherapy demonstrate significant overall survival benefits.
• Triplet therapy (ADT, docetaxel, ARSI) shows efficacy, especially in high-volume metastatic disease.
• Improved disease detection via PSMA PET-CT and personalized strategies through genomic profiling.

Conclusions:

• Combination therapies are the standard of care for mHSPCa, offering improved survival.
• Precision-based, multidisciplinary approaches incorporating advanced diagnostics and novel therapies are crucial for future mHSPCa management.
• Balancing treatment efficacy with tolerability is essential for optimizing patient outcomes.