Avoid common mistakes on your manuscript.
Metastatic hormone-sensitive prostate cancer (mHSPC) is a heterogeneous disease state that requires comprehensive and personalized management [1]. Androgen deprivation therapy (ADT) alone has long been the standard of care for mHSPC [2, 3]. However, recent advancements in treatment and imaging modalities have transformed the management landscape of mHSPC, making it even more complex.
One of the key advancements in the treatment of mHSPC has been the introduction of combination systemic therapies, such as the addition of docetaxel and/or androgen receptor signaling inhibitor (ARSI) to ADT and the incorporation of local therapy for the low-volume disease [4,5,6,7,8]. These approaches have been shown to significantly improve survival and delay disease progression in patients with mHSPC [9].
Additionally, the diagnosis, monitoring, and management of mHSPC have undergone significant change with the introduction of prostate-specific membrane antigen (PSMA) positron emission tomography (PET) imaging; this is particularly true for the metachronous mHSPC [10, 11]. For prostate cancer, PSMA-PET imaging offers a more sensitive and specific molecular imaging modality that enables more accurate diagnosis and potential individualized treatment strategies [1]. Furthermore, recent studies have demonstrated the effectiveness and safety of metastasis-directed therapy (MDT) guided by PSMA-PET findings in patients with oligometastatic disease [12, 13].
Another important aspect is genomic profiling, which has also emerged as a potentially important tool in the management of mHSPC. By analyzing the genetic makeup of patient's tumor, clinicians can identify molecular targets for existing personalized treatments; some of them are still under investigation for men with mHSPC, but have already been approved in metastatic-castration-resistant prostate cancer (mCRPC) [1, 14]. For example, genomic profiling can identify mutations in genes such as BRCA2 and ATM, which are associated with higher response rate to certain therapies such as PARP inhibitors [14,15,16].
In closing, with the introduction of new combination systemic agents, local therapies, genomic profiling, and imaging modalities, the therapy of mHSPC is rapidly evolving. These advancements already offer unique opportunities to optimize patients outcomes and improve the quality of life for men with mHSPC. Future developments will aim to improve outcomes and lessen treatment-related toxicity. As such, clinicians need to stay up-to-date on the latest developments in this field to to ensure that patients receive the most effective therapies available, which should be based on an individualized strategy tailored to each patient's specific traits and disease status.
References
Lokeshwar SD, Choksi AU, Haltstuch D et al (2023) Personalizing approaches to the management of metastatic hormone sensitive prostate cancer: role of advanced imaging, genetics and therapeutics. World J Urol. https://doi.org/10.1007/s00345-023-04409-9
Gravis G et al (2013) Androgen-deprivation therapy alone or with docetaxel in non-castrate metastatic prostate cancer (GETUG-AFU 15): a randomised, open-label, phase 3 trial. Lancet Oncol 14(2):149–158
Chen K, Kostos L, Azad AA (2022) Future directions in systemic treatment of metastatic hormone-sensitive prostate cancer. World J Urol. https://doi.org/10.1007/s00345-022-04135-8
Baboudjian M, Roubaud G, Fromont G et al (2022) What is the ideal combination therapy in de novo, oligometastatic, castration-sensitive prostate cancer? World J Urol. https://doi.org/10.1007/s00345-022-04239-1
Parker CC et al (2018) Radiotherapy to the primary tumour for newly diagnosed, metastatic prostate cancer (STAMPEDE): a randomised controlled phase 3 trial. Lancet 392(10162):2353–2366
Rajwa P et al (2023) Association between age and efficacy of combination systemic therapies in patients with metastatic hormone-sensitive prostate cancer: a systematic review and meta-analysis. Prostate Cancer Prostatic Dis 26(1):170–179
Kafka M, Burtscher T, Fritz J et al (2022) Real-world comparison of docetaxel versus new hormonal agents in combination with androgen-deprivation therapy in metastatic hormone-sensitive prostate cancer descrying PSA Nadir ≤ 0.05 ng/ml as marker for treatment response. World J Urol. https://doi.org/10.1007/s00345-022-04189-8
Yanagisawa T, Kimura T, Hata K et al (2022) Combination of docetaxel versus nonsteroidal antiandrogen with androgen deprivation therapy for high-volume metastatic hormone-sensitive prostate cancer: a propensity score-matched analysis. World J Urol. https://doi.org/10.1007/s00345-022-04030-2
Matsumura N, Fujita K, Nishimoto M et al (2022) Current status and future perspectives of the managements of metastatic hormone-sensitive prostate cancer. World J Urol. https://doi.org/10.1007/s00345-022-04134-9
Zaorsky NG et al (2021) Salvage therapy for prostate cancer after radical prostatectomy. Nat Rev Urol 18(11):643–668
Hofman MS et al (2020) Prostate-specific membrane antigen PET-CT in patients with high-risk prostate cancer before curative-intent surgery or radiotherapy (proPSMA): a prospective, randomised, multicentre study. Lancet 395(10231):1208–1216
Pellegrino A, Gandaglia G, de Angelis M et al (2023) Oncological and perioperative outcomes of surgery with or without metastasis-directed therapy as part of a multimodal treatment in men with de-novo oligometastatic prostate cancer. World J Urol. https://doi.org/10.1007/s00345-023-04460-6
Tsaur I, Blaheta RA, Dotzauer R et al (2022) Focal therapy for primary tumor and metastases in de novo or recurrent oligometastatic prostate cancer: current standing and future perspectives. World J Urol. https://doi.org/10.1007/s00345-022-04162-5
Teyssonneau D et al (2021) Prostate cancer and PARP inhibitors: progress and challenges. J Hematol Oncol 14(1):51
Rajwa P et al (2023) Prostate cancer risk, screening and management in patients with germline BRCA1/2 mutations. Nat Rev Urol 20(4):205–216
Rebhan K, Stelzer PD, Pradere B et al (2023) Performance of clinical risk scores and prediction models to identify pathogenic germline variants in patients with advanced prostate cancer. World J Urol. https://doi.org/10.1007/s00345-023-04535-4
Author information
Authors and Affiliations
Corresponding author
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Rajwa, P., Quhal, F. & Tsaur, I. Current Management and Future Treatment Strategies for Patients with Metastatic Hormone-Sensitive Prostate Cancer. World J Urol 41, 2005–2006 (2023). https://doi.org/10.1007/s00345-023-04542-5
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00345-023-04542-5