Treatment Decisions in Patients With Low- vs High-Volume Disease

Summary for Physicians: Treatment Decisions Based on Disease Volume

The impact of disease volume (high vs low) on treatment selection:

• Both androgen receptor (AR) pathway inhibitors (enzalutamide and darolutamide) demonstrate benefit regardless of disease volume.
• The magnitude of benefit may differ between high-volume and low-volume disease subgroups.
• In high-volume disease: Consider more aggressive approaches; combination therapy may provide more substantial benefits.
• In low-volume disease: AR pathway inhibitors show particularly favorable outcomes, potentially allowing some patients to delay chemotherapy.

Clinical decision-making implications:

• Disease volume should be 1 factor among several in treatment selection.
• Individual patient characteristics (age, comorbidities, performance status) remain critical considerations.
• Treatment goals (rapid disease control vs quality-of-life prioritization) may vary based on disease burden.
• Regular reassessment of disease status is important as volume can change over time.

Treatment decisions should be individualized through shared decision-making that considers disease volume alongside other patient-specific factors.