Addressing Unmet Needs in mCSPC Care

This segment explores the unmet needs and future directions in managing metastatic castration-sensitive prostate cancer (mCSPC). Panelists discuss the critical balance between treatment intensification and de-intensification, emphasizing the need to identify which patients can achieve optimal outcomes with less therapy and which require escalation to triplet regimens. They highlight emerging trials, including TRIPLE SWITCH, TALAPRO-3, and studies integrating PARP inhibitors, radioligand therapy, and novel mechanisms of action for high-risk or genomically defined subgroups. The conversation also underscores the importance of biomarker-driven precision medicine, such as using genomic assays like Decipher or testing for BRCA1/2, PTEN, and PIK3 pathway alterations to personalize care. Panelists agree that the next frontier lies in refining therapy duration, incorporating targeted radiation and systemic combinations, and leveraging biologic insights to optimize outcomes—transforming prostate cancer treatment from a “one-size-fits-all” model to a tailored, precision-based approach that maximizes efficacy while minimizing toxicity.

Panelists noted that abiraterone, apalutamide, and enzalutamide demonstrate overall survival benefits, while darolutamide primarily delays progression. They discussed side-effect profiles and monitoring needs—highlighting the need for liver function monitoring and steroid co-administration with abiraterone—and emphasized that treatment selection often depends on balancing efficacy, toxicity, and clinician comfort.