Strategic Use of ADT in mCSPC From Selection to Escalation

The panel discusses real-world decision-making when choosing between oral and injectable ADT at treatment initiation, emphasizing cardiovascular risk, patient logistics, adherence, and lifestyle considerations. Faculty highlight the clinical relevance of rapid testosterone suppression and recovery with oral ADT, particularly for patients considering intermittent therapy, those with cardiovascular comorbidities, or individuals who travel long distances for care. The discussion also explores how ADT choice fits within broader treatment strategies, including doublet and triplet therapy, noting that ARPI selection is often driven by comorbidities, drug interactions, access, and cost rather than the ADT backbone itself. Finally, the panel underscores the importance of shared decision-making, patient autonomy, and fitness for chemotherapy when escalating therapy intensity in mCSPC.

The next episode in this series, ‘InterpretingPSMA PET Imaging in mCSPC’, features the panelists discussing the increasing complexity of interpreting PSMA PET findings, particularly when lesions are indeterminate or lack confirmatory imaging correlates. Faculty highlight how uncertainty in advanced imaging can influence decisions to observe, repeat imaging, or defer treatment rather than act on potentially false-positive findings.