[Treatment of metastatic hormone-sensitive prostate cancer]

For many years, androgen deprivation therapy (ADT) alone was considered the established standard of care for metastatic hormone-sensitive prostate cancer (mHSPC). A paradigm shift was initiated by the CHAARTED trial, which for the first time demonstrated a significant overall survival benefit with the addition of docetaxel to ADT. Further randomized trials also revealed a clinical benefit from intensifying ADT with the modern hormonal agents abiraterone, apalutamide, darolutamide and enzalutamide. Moreover, the triplet combination of darolutamide, ADT and docetaxel was shown to provide a survival advantage compared with chemo-hormonal therapy alone. These combination approaches are now considered the standard of care in mHSPC. Although the introduction of these treatment strategies has substantially prolonged median overall survival in patients with mHSPC, a considerable proportion of patients still experience early mortality during the course of the disease. Consequently, a significant unmet need for novel therapeutic options remains. This article aims to review first-line treatment options in the mHSPC setting and highlight their differences to support evidence-based therapeutic decision-making. In addition, emerging developments are discussed with the goal of further improving clinical outcomes.