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Personalizing approaches to the management of metastatic hormone sensitive prostate cancer: role of advanced imaging, genetics and therapeutics

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Abstract

Purpose

To summarize contemporary and emerging strategies for the diagnosis and management of metastatic hormone sensitive prostate cancer (mHSPC), focusing on diagnostic testing and therapeutics.

Methods

Literature review using PUBMED-Medline databases as well as clinicaltrials.gov to include reported or ongoing clinical trials on treatment for mHSPC. We prioritized the findings from phase III randomized clinical trials, systematic reviews, meta-analyses and clinical practice guidelines.

Results

There have been significant changes to the diagnosis and staging evaluation of mHSPC with the integration of increasingly accurate positron emission tomography (PET) imaging tracers that exceed the performance of conventional computerized tomography (CT) and bone scan. Germline multigene testing is recommended for the evaluation of patients newly diagnosed with mHSPC given the prevalence of actionable alterations that may create candidacy for specific therapies. Although androgen deprivation therapy (ADT) remains the backbone of treatment for mHSPC, approaches to first-line treatment include the integration of multiple agents including androgen receptor synthesis inhibitors (ARSI; abiraterone) Androgen Receptor antagonists (enzalutamide, darolutamide, apalautamide), and docetaxel chemotherapy. The combination of ADT, ARSI, and docetaxel chemotherapy has recently been evaluated in a randomized trial and was associated with significantly improved overall survival including in patients with a high burden of disease. The role of local treatment to the prostate with radiation has been evaluated in randomized trials with additional studies underway evaluating the role of cytoreductive radical prostatectomy.

Conclusion

The staging and initial management of patients with mHSPC has undergone significant advances in the last decade with advancements in the diagnosis, treatment and sequencing of therapies.

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Authors and Affiliations

  1. Department of Urology, Yale University School of Medicine, New Haven, CT, 06511, USA

    Soum D. Lokeshwar, Ankur U. Choksi, Daniel Haltstuch, Syed N. Rahman, Benjamin H. Press, Jamil Syed, Michael E. Hurwitz, Isaac Y. Kim & Michael S. Leapman

  2. Department of Urology, Yale School of Medicine, 310 Cedar Street, BML 238C, New Haven, CT, 06520, USA

    Michael S. Leapman

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  7. Michael E. Hurwitz
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  9. Michael S. Leapman
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Contributions

SD Lokeshwar: protocol/project development, data collection and management, data analysis, manuscript writing/editing. AU Choksi: data collection and management, data analysis, manuscript writing/editing. D Haltstuch: manuscript writing/ editing. SN Rahman: manuscript writing/editing. BH Press: manuscript writing/editing. J Syed: protocol/ project development, manuscript editing. ME Hurwitz: manuscript editing. IY Kim: manuscript editing. MS Leapman: protocol/project development, data collection and management, data analysis, manuscript writing/editing.

Corresponding author

Correspondence to Michael S. Leapman.

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Disclosure of potential conflicts of interest: SD Lokeshwar, AU Choksi, D Haltstuch, SN Rahman, BH Press, J syed, ME Hurwitz, IY Kim, MS Leapman have no potential conflict of interest.

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Lokeshwar, S.D., Choksi, A.U., Haltstuch, D. et al. Personalizing approaches to the management of metastatic hormone sensitive prostate cancer: role of advanced imaging, genetics and therapeutics. World J Urol 41, 2007–2019 (2023). https://doi.org/10.1007/s00345-023-04409-9

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