First-Line mHSPC Therapy: AR Inhibitors vs Chemotherapy

Clinical Brief: Personalizing Treatment Selection in Metastatic Prostate Cancer

Main Discussion Topics

• Triplet Therapy Indications: High-volume, high-risk symptomatic disease with visceral metastases
• Patient Selection for Chemotherapy: Younger, chemotherapy-fit patients with visceral disease and high symptom burden
• Alternative Approaches: Doublet therapy for chemotherapy-reluctant or unfit patients
• Shared Decision-Making: Balancing treatment efficacy with patient preferences and quality of life goals

Key Points for Physicians

• Chemotherapy is particularly beneficial for patients requiring rapid tumor reduction
• Doublet therapy preferred for low-volume/low-risk disease or patients without adverse molecular markers
• Androgen deprivation monotherapy may be appropriate for elderly patients with high frailty scores or significant comorbidities
• Patient education about treatment rationale is essential for informed consent and decision-making

Notable Insights

The presenter acknowledges that chemotherapy is not an easy treatment to endure and emphasizes the importance of helping patients understand the clinical rationale and benefits to make the best personal decision.

Clinical Significance

Treatment selection in metastatic prostate cancer requires balancing objective disease characteristics with patient-specific factors through shared decision-making to optimize both clinical outcomes and quality of life.