Opinion
Video
First-Line mHSPC Therapy: AR Inhibitors vs Chemotherapy
Author(s):
Paul E. Dato, MD, discusses how treatment selection between triplet therapy, doublet therapy, or androgen deprivation monotherapy should be based on disease volume, risk factors, patient age, fitness for chemotherapy, and patient preferences through shared decision-making.
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.
