Evolving Systemic Therapies in mCSPC

Welcome back to another Urology Times Peer Exchange series. In this episode, titled “Evolving Systemic Therapies in mCSPC,” expert faculty discuss how the treatment landscape for metastatic castration-sensitive prostate cancer (mCSPC) has evolved from androgen deprivation therapy alone to a more intensive and personalized treatment approach. The panel highlights the growing role of androgen receptor pathway inhibitor (ARPI)-based doublet therapy as the current standard of care and reviews how emerging therapies are further expanding treatment options.

The panel of experts examines factors driving the rapid evolution of systemic therapy, including advances in molecular profiling, next-generation sequencing, biomarker-driven treatment selection, and improvements in imaging technologies such as prostate-specific membrane antigen (PSMA)-PET. Faculty discuss how these innovations are enabling a more individualized approach to patient care and helping clinicians identify patients who may benefit from targeted therapies, including PARP inhibitor combinations and other emerging treatment strategies.

The discussion also explores how clinicians approach initial treatment selection in mCSPC when multiple guideline-supported options are available. The panel reviews the role of disease volume, timing of metastatic presentation, patient comorbidities, treatment goals, and molecular characteristics in guiding treatment decisions. In addition, faculty examine how current guideline recommendations from organizations such as the National Comprehensive Cancer Network and American Urological Association/Society of Urologic Oncology provide a framework for decision-making despite the lack of direct comparative data between available therapies.

In the next episode, “Personalizing ARPI Selection in mCSPC,” panelists will continue their discussion of mCSPC and highlight how clinicians differentiate among ARPI-based doublet therapies based on patient characteristics, treatment tolerability, and emerging evidence. The panel also reviews age-related considerations, the role of abiraterone and steroid exposure, and how evolving combination strategies may influence future treatment decisions.