Opinion
Video
Treatment Strategies for Symptomatic Bone Metastases in mHSPC
Author(s):
Paul E. Dato, MD, discusses how triplet therapy involving ADT, docetaxel chemotherapy, and an androgen receptor targeting agent would be the best treatment option for this patient with high-volume, high-risk symptomatic metastatic disease including hepatic involvement.
Clinical Brief: Treatment Options for Recurrent Metastatic Prostate Cancer
Main Discussion Topics
- Triplet Therapy: Androgen deprivation therapy (ADT) with docetaxel chemotherapy and an androgen receptor (AR)–targeted agent (abiraterone or darolutamide)
- Clinical Trial Evidence: PEACE-1 and ARASENS trials demonstrating survival benefits with triplet therapy
- Alternative Approaches: Doublet therapy options (ADT with AR pathway inhibitors) and bone-directed therapies
- Emerging Therapies: Potential future role of radiopharmaceuticals in hormone-sensitive disease
Key Points for Physicians
- Triplet therapy shows statistically significant improvements in radiographic progression-free survival and overall survival
- Available AR pathway inhibitors include abiraterone (branded, generic, or micronized), enzalutamide, and apalutamide
- Liver metastases associated with more rapid progression and shorter survival compared to bone/lymph node–only disease
- Bone-directed therapies (zoledronic acid or denosumab) indicated to reduce skeletal-related events
Notable Insights
The presenter notes that while radiopharmaceuticals like radium-223 and PSMA-based lutetium-177 are currently approved only for castration-resistant disease, future studies may establish their efficacy in hormone-sensitive settings.
Clinical Significance
Treatment selection for recurrent metastatic prostate cancer requires consideration of disease volume, metastatic sites, patient characteristics, and emerging evidence for novel therapeutic combinations to optimize survival outcomes.
