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Therapy Optimization in mHSPC: Insights from a Multidisciplinary Uro-Oncology Expert Panel
André Mansinho1,2, João Carlos Gramaça3,4, Rodrigo Ramos5
1START Lisbon, Unidade Local de Saúde Santa Maria, Lisbon, Portugal. andre.mansinho@startlisbon.com.
Advances in Therapy
|May 23, 2026
Summary
Treatment intensification, including androgen receptor pathway inhibitors (ARPIs) with androgen deprivation therapy (ADT), improves outcomes for metastatic hormone-sensitive prostate cancer (mHSPC). Expert consensus guides patient selection to balance efficacy and toxicity.
Area of Science:
- Oncology
- Urology
- Pharmacology
Background:
- Metastatic hormone-sensitive prostate cancer (mHSPC) is an early, treatment-sensitive stage before castration resistance.
- Current treatment involves androgen deprivation therapy (ADT), with options for intensification or optimization.
- Treatment intensification aims for sustained tumor regression by combining mechanisms of action.
Purpose of the Study:
- To discuss the role of treatment intensification in mHSPC.
- To identify patient subgroups likely to benefit from specific intensified treatment strategies.
- To provide expert consensus on managing advanced prostate cancer.
Main Methods:
- A panel of 28 experts (8 urologists, 20 oncologists) with advanced prostate cancer expertise convened.
- Discussions focused on the role of treatment intensification in mHSPC.
- Expert opinions were gathered on patient selection for different treatment strategies.
Main Results:
- Randomized controlled trials show improved outcomes with ADT plus ARPIs, and ADT plus ARPIs plus docetaxel.
- Treatment intensification decisions in mHSPC have clinically meaningful implications.
- Comparative efficacy data is lacking, necessitating individualized treatment choices.
Conclusions:
- Treatment intensification strategies offer improved outcomes in mHSPC.
- Patient and disease factors guide treatment selection to optimize efficacy and minimize toxicity.
- Expert consensus can aid in navigating complex treatment decisions for advanced prostate cancer.
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