Why ADT Alone Is No Longer Sufficient in Metastatic Castration Sensitive Prostate Cancer (mCSPC)

In this segment, Dr. Charles J. Ryan asks Dr. Alan H. Bryce to explain why androgen deprivation therapy (ADT) alone is no longer considered adequate treatment for most patients with metastatic castration sensitive prostate cancer (mCSPC). Dr. Bryce reviews the evolution of evidence from multiple randomized phase 3 trials demonstrating that treatment intensification with additional systemic agents improves overall survival compared with ADT alone. He discusses how therapies targeting the androgen receptor signaling pathway and combination approaches have reshaped the standard of care in mCSPC. The conversation highlights that these strategies aim to suppress tumor growth more effectively during the hormone sensitive phase of disease, when prostate cancer remains most responsive to therapy. Dr. Bryce also notes that earlier intervention with combination treatment may delay disease progression and extend survival for many patients. The discussion reinforces how growing clinical evidence has shifted treatment paradigms toward intensified upfront management in metastatic castration sensitive prostate cancer.