Controversies in metastatic hormone-sensitive prostate cancer

Area of Science:

• Oncology
• Urology
• Medical Imaging

Background:

• Metastatic hormone-sensitive prostate cancer (mHSPC) remains an incurable disease.
• Current diagnostic and management strategies for mHSPC are evolving.
• Optimal treatment selection is complex and may not involve simply adding more therapies.

Purpose of the Study:

• To critically review four major controversies in mHSPC management.
• To evaluate the evidence for specific diagnostic and therapeutic approaches.
• To guide clinicians in refining treatment strategies for improved patient outcomes.

Main Methods:

• Literature review and critical evaluation of existing data.
• Focus on four key areas: PSMA PET imaging, triplet therapy, radiation, and bone agents.
• Analysis of controversies to identify areas needing further research.

Main Results:

• The role of prostate-specific membrane antigen positron emission tomography (PSMA PET) scans in diagnosis is debated.
• The efficacy and patient selection for triplet therapy (ADT, ARPI, docetaxel) require further clarification.
• Optimal use of radiation and bone-modifying agents in mHSPC needs more investigation.

Conclusions:

• Further research is essential to identify patient subgroups who benefit from specific mHSPC treatments.
• A deeper understanding of current controversies can help refine clinical practice.
• The ultimate goal is to enhance both the quantity and quality of life for patients with mHSPC.