Evidence Gaps in mCSPC

In this episode, “Evidence Gaps in mCSPC,” the panelists explore some of the most important unanswered questions in the management of metastatic castration-sensitive prostate cancer (mCSPC). As treatment options continue to expand, the expert faculty discuss where current evidence remains limited and identify key areas for future research that may further refine treatment selection and disease management.

The panel of experts examines the growing interest in treatment de-intensification strategies for patients who achieve deep and durable responses to therapy. They discuss emerging data evaluating treatment holidays, testosterone recovery, and the potential role of carefully selected treatment pauses for patients who achieve substantial PSA declines. Faculty highlight the need for additional evidence to better understand which patients may safely benefit from these approaches and how long treatment interruptions can be maintained.

The discussion also focuses on the clinical significance of PSA-based response metrics, including PSA90 and PSA levels below 0.2 ng/mL, as potential indicators of long-term outcomes. The panelists review emerging data suggesting that patients who fail to achieve deep PSA responses may face a significantly higher risk of disease progression and mortality, raising important questions regarding treatment intensification and earlier intervention strategies. The panel explores the need for predictive biomarkers and other tools that may help identify which patients are most likely to benefit from specific therapies and guide more personalized treatment strategies in the future.

The next episode in this series, “Applying Real-World Evidence to mCSPC Care,” features the panelists discussing how they make treatment decisions in the absence of head-to-head ARPI trials and the role of retrospective studies, real-world evidence, and network meta-analyses in clinical practice. They also highlight how access, cost, patient characteristics, and broader population data influence treatment selection and evidence interpretation in mCSPC.