Treatment Strategies for Metastatic Castration-Sensitive Prostate Cancer: Current Evidence and Future Directions

Metastatic castration-sensitive prostate cancer (mCSPC) is a biologically heterogeneous disease with a variable clinical course. Over the past decade, the treatment landscape for mCSPC has evolved significantly, shifting from androgen deprivation therapy (ADT) alone to combination approaches, including chemotherapy and novel androgen receptor pathway inhibitors. Landmark trials, such as CHAARTED, STAMPEDE, and LATITUDE, have demonstrated significant survival benefits with the addition of docetaxel or abiraterone to ADT, leading to changes in clinical guidelines and practice. More recently, triplet therapies combining ADT, docetaxel, and androgen receptor signaling inhibitors have shown further improvement in patient outcomes, although optimal patient selection remains unclear. Furthermore, advances in molecular profiling and imaging have enabled more precise stratification of patients, allowing for personalized treatment strategies. This review provides a comprehensive overview of the current evidence regarding treatment strategies for mCSPC, including key clinical trials, real-world data, and ongoing research. Additionally, we discuss emerging therapies and potential future directions, such as the integration of novel agents targeting DNA repair pathways or radiopharmaceuticals targeting prostate-specific membrane antigen. As the therapeutic landscape continues to expand, a more nuanced understanding of disease biology and patient characteristics is essential for guiding individualized care and improving long-term outcomes in men with mCSPC.