Treatment Selection in Advanced Prostate Cancer

The panelists highlight how treatment selection in advanced prostate cancer has evolved significantly over the past decade, driven by advances in imaging, genomics, and systemic therapy options. The panel highlights the growing role of PSMA PET in refining disease staging and reclassifying patients previously thought to have lower-risk disease, which in turn influences ADT duration and intensification strategies. Germline and genomic testing are emphasized as central to prognostication, treatment selection, and monitoring, with emerging data guiding decisions around doublet versus triplet therapy. The discussion also underscores real-world challenges in integrating genomics and baseline testosterone assessment into clinical workflows, particularly within busy urology practices, as care becomes more personalized and complex.

In the next episode, ‘Strategic Use of ADT in mCSPC From Selection to Escalation’, panelists will continue their discussion on advanced prostate cancer and highlight how clinicians select between oral and injectable ADT as the backbone of therapy in mCSPC and how those choices integrate with ARPI selection. The conversation then explores decision-making around treatment escalation from doublet to triplet therapy, balancing potential benefit with cumulative toxicity and patient-specific factors.