A panelist discusses how clinicians should weigh the decision between enzalutamide and darolutamide for patients with metastatic hormone-sensitive prostate cancer (mHSPC) by considering each drug’s efficacy profile alongside their distinct adverse effect patterns, particularly darolutamide’s favorable central nervous system (CNS) toxicity profile vs enzalutamide’s more established long-term data, while also factoring in individual patient characteristics such as age, comorbidities, and potential drug interactions.