Adam Weiner, MD, on therapeutic decision-making in metastatic prostate cancer

The cornerstone for first-line treatment in metastatic prostate cancer is androgen deprivation therapy (ADT), although there are several other options that can be used to personalize treatment to the individual patient, according to Adam B. Weiner, MD.

Weiner recently sat down with Urology Times® to discuss current treatment options for patients with metastatic prostate cancer in the wake of former President Joe Biden’s recent diagnosis.¹

“There are a lot of variables and factors in deciding what might be the entire first-line of therapy. The nice thing is that patients have options, and that's what's been really important and really gratifying to see as prostate cancer research has matured in the past 5 years,” he noted.

Weiner is a urologist at Cedars-Sinai Medical Center in Los Angeles, California.

Aside from ADT, patients may also be offered next-level hormonal therapies, which block hormone receptors or prevent hormone production in the adrenal glands. However, this choice should be tailored to each patients’ health profile, with avoidance for patients with cardiac issues or a history of stroke, according to Weiner.

He also noted that chemotherapy is increasingly being used early but must be weighed against potential side effects and patients’ other medical issues.

Additionally, radiopharmaceuticals, like PSMA-targeted radioligand therapy, are generally reserved for late-stage, castration-resistant disease. Radiation may also be used for metastasis-directed therapy or to the prostate itself in low-volume metastatic cases.

Overall, he says, the treatment landscape has broadened significantly, giving patients more personalized options.

REFERENCE

1. Biden diagnosed with ‘aggressive form’ of prostate cancer. CNN. May 19, 2025. Accessed June 5, 2025. https://edition.cnn.com/2025/05/18/politics/joe-biden-prostate-cancer