Assessing Comorbidities in mCSPC Management

In this segment, panelists discussed how patient comorbidities, cognitive status, and lifestyle factors influence selection of androgen receptor pathway inhibitors (ARPIs) for metastatic castration-sensitive prostate cancer (mCSPC). They emphasized that long-term adherence and tolerability are critical to achieving sustained disease control. Key considerations include cardiovascular health, diabetes, cognitive impairment, seizure history, and fall risk, all of which may guide the choice between agents such as abiraterone, enzalutamide, apalutamide, and darolutamide. Panelists noted that patients with heart failure or diabetes may be less suitable for abiraterone due to steroid use, while those with cognitive decline or seizure history may tolerate darolutamide better. They also highlighted practical issues such as dosing schedules, drug–drug interactions, and coordination with primary care or cardiology to manage comorbidities. The discussion underscored the importance of individualized therapy, prioritizing both safety and sustained compliance to optimize outcomes in mCSPC management.

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.