Combination Therapy and Treatment Adherence Strategies in mCSPC

This segment focused on strategies to individualize treatment and sustain adherence among patients with metastatic castration-sensitive prostate cancer (mCSPC). Panelists emphasized that long-term success depends not only on selecting the right regimen—whether doublet or triplet—but also on maintaining tolerability and compliance. Treatment selection continues to hinge on patient-specific factors such as comorbidities, frailty, fall risk, fatigue, and genetic profile, with decisions often guided by practical experience and nuanced drug characteristics. To support adherence, clinicians discussed the value of frequent patient touchpoints through in-house pharmacies, chronic care teams, and proactive symptom management. Interventions like addressing fatigue, mitigating hot flashes, and encouraging physical activity were cited as essential for sustaining therapy. Ultimately, the panel underscored a multidisciplinary “village” approach to optimizing long-term 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.