Preserving Quality of Life in Metastatic Castration-Sensitive Prostate Cancer

In this episode, “Preserving Quality of Life in Metastatic Castration-Sensitive Prostate Cancer,” the expert faculty explore how cognitive function, independence, and patient priorities influence treatment selection for metastatic castration-sensitive prostate cancer (mCSPC). Through the case of a 74-year-old man with low-volume metastatic disease, mild cognitive impairment, and a strong desire to maintain an active lifestyle, the panel examines the importance of treating the whole patient rather than focusing solely on disease characteristics.

The discussion highlights how factors such as physiological age, baseline cognitive function, fall risk, and quality-of-life goals can shape therapeutic decision-making. Expert faculty review considerations for selecting androgen receptor pathway inhibitors (ARPIs), including emerging evidence regarding central nervous system penetration and potential cognitive effects. The panel also explores how clinicians can assess cognitive function in busy clinical practice, the role of family members in identifying subtle changes, and when referral to neurocognitive or geriatric oncology specialists may be appropriate.

The faculty review findings from the COGCAP and ARACOG studies, discussing their implications for understanding cognitive outcomes among patients receiving ARPI-based therapy. The conversation also addresses treatment adherence, pill burden, the impact of concomitant medications, and strategies for balancing efficacy with preservation of independence and daily functioning. Throughout the episode, the panel emphasizes the importance of shared decision-making, ongoing assessment of treatment-related effects, and individualized care plans that align with patient goals. As patients move through the advanced prostate cancer continuum, maintaining quality of life remains a critical consideration alongside disease control and long-term outcomes.

The next episode in this series, “Managing High-Risk Biochemical Recurrence in Advanced Prostate Cancer,” features the panelists discussing how PSA doubling time, patient comorbidities, and emerging clinical trial data influence treatment decisions after biochemical recurrence. The panel explores treatment intensification strategies, metastasis-directed therapy, and the evolving role of systemic treatment in patients at high risk for disease progression.