Emerging Treatment Strategies in mCSPC

This episode, titled “Emerging Treatment Strategies in mCSPC,” features panelists discussing the rapidly evolving treatment landscape in metastatic castration-sensitive prostate cancer (mCSPC) and the growing number of therapeutic approaches being incorporated alongside androgen deprivation therapy (ADT) and androgen receptor pathway inhibitors (ARPIs). The expert faculty review how emerging strategies, including PARP inhibitors, AKT inhibitors, metastasis-directed therapy (MDT), and PSMA-targeted radioligand therapies, are expanding treatment possibilities and creating new opportunities for personalized care.

The panel of experts highlights the impact of PSMA PET imaging on disease staging and treatment planning, particularly for patients with oligometastatic disease. They discuss how advances in imaging have led to greater adoption of metastasis-directed therapy and the integration of local and systemic approaches aimed at improving long-term disease control. Faculty also examine the growing use of PARP inhibitor combinations in biomarker-selected populations and discuss the potential future role of therapies targeting PTEN-deficient disease and PSMA-positive tumors.

Throughout the discussion, the panelists emphasize that ADT plus ARPI remains the therapeutic backbone across treatment strategies, while emerging agents may further intensify or personalize therapy for selected patients. They also explore how increasing treatment options create new questions regarding sequencing and duration of therapy. In addition, the expert faculty discuss the concept of treatment de-intensification in carefully selected patients, including the possibility of treatment holidays and close surveillance following robust responses. The panel considers the balance between maximizing disease control and minimizing long-term treatment-related toxicities, underscoring the need for individualized decisions as evidence continues to evolve.

In the next episode, “Evidence Gaps in mCSPC,” panelists will discuss key unanswered questions in metastatic castration-sensitive prostate cancer, including treatment de-intensification, the role of deep PSA responses, and strategies for patients with suboptimal treatment outcomes. The panel will also explore the need for predictive biomarkers, prospective comparative studies, and other advances that may help personalize treatment decisions in the future.