Current Treatment Landscape and Guideline Recommendations in mCSPC

In this peer exchange, expert faculty opened the discussion by outlining the evolving management of metastatic castration-sensitive prostate cancer (mCSPC). Panelists noted that androgen deprivation therapy (ADT) alone, once the historical standard, has been replaced by combination approaches that improve survival outcomes.

They discussed the role of androgen receptor pathway inhibitors (ARPIs)—including abiraterone, enzalutamide, apalutamide, and darolutamide—with several showing clear overall survival benefits. Panelists explained that current guidelines from NCCN and AUA recommend both doublet (ADT + ARPI) and triplet (ADT + ARPI + chemotherapy) therapy as category 1 options, with treatment individualized based on patient age, disease volume, and preferences.

They emphasized that ADT monotherapy is now considered suboptimal except in limited clinical scenarios, and combination therapy should be pursued whenever feasible to provide more durable disease control.