Integrating Genomic Testing into mCSPC Management

This segment focuses on the evolving role of genomic testing in metastatic castration-sensitive prostate cancer (mCSPC) and its influence on treatment decisions. Panelists emphasize the increasing adoption of paired somatic and germline testing at diagnosis, allowing earlier identification of aggressive disease markers such as TP53, RB1, PTEN loss, BRCA2 mutations, MSI-high status, and SPOP variants. Early testing enables clinicians to anticipate prognosis, guide therapy intensity (e.g., doublet vs. triplet), and prepare for future use of targeted agents such as PARP inhibitors once disease progression occurs. The discussion also explores testing logistics, with community and academic settings employing next-generation sequencing (NGS), liquid biopsies, and metastatic-directed sampling depending on access and feasibility. Despite challenges with tissue quality and accessibility, early and repeat testing remain essential to inform personalized care strategies. Ultimately, genomic profiling represents a paradigm shift in tailoring therapy and anticipating resistance in advanced prostate cancer management.

Panelists noted that abiraterone, apalutamide, and enzalutamide demonstrate overall survival benefits, while darolutamide primarily delays progression. They discussed side-effect profiles and monitoring needs—highlighting the need for liver function monitoring and steroid co-administration with abiraterone—and emphasized that treatment selection often depends on balancing efficacy, toxicity, and clinician comfort.