Personalizing ARPI Selection in mCSPC

In this episode, “Personalizing ARPI Selection in mCSPC,” the panelists explore how clinicians differentiate among available androgen receptor pathway inhibitor (ARPI)-based doublet therapies for patients with metastatic castration-sensitive prostate cancer (mCSPC). As treatment options continue to expand, expert faculty discuss the increasingly individualized nature of treatment selection and the importance of aligning therapy choice with patient-specific factors, comorbidities, and treatment goals.

The panel of experts examines how clinical experience, patient preferences, and toxicity considerations influence therapeutic decisions in everyday practice. They discuss factors such as long-term steroid exposure, treatment tolerability, and the availability of alternative options when selecting among ARPI-based regimens. Faculty emphasize that treatment selection is rarely a one-size-fits-all process and requires ongoing communication between clinicians and patients. The discussion also highlights data from the STAMPEDE meta-analysis evaluating outcomes across age groups and explores how these findings may influence the use of abiraterone in older patients. Panelists consider the potential impact of steroid-associated toxicities and discuss circumstances in which abiraterone may still play an important role in treatment strategies.

In addition, the expert faculty review the growing role of combination approaches, including PARP inhibitor-based regimens, and discuss how emerging therapies may influence future treatment pathways. The panel underscores the challenges associated with selecting among multiple guideline-supported options in the absence of direct comparative phase 3 trials and highlights how clinicians often rely on patient characteristics, indirect evidence, and real-world experience to guide treatment decisions.

The next episode in this series, “Risk Stratification and Treatment Intensification Strategies in mCSPC,” features the panelists discussing how clinical, molecular, and genomic risk factors influence treatment selection and intensification strategies for patients with metastatic castration-sensitive prostate cancer. The panel also highlights the growing role of NGS testing, multidisciplinary care, and emerging predictive tools in personalizing treatment decisions and improving patient outcomes.