Year: 2026
Type: article
Abstract: Metastatic hormone-sensitive prostate cancer (mHSPC) is a disease state characterized by the presence of distant metastases detectable on conventional imaging while the tumor remains responsive to androgen deprivation therapy (ADT). It represents an earlier, treatment-sensitive phase that precedes the development of metastatic castration-resistant prostate cancer (mCRPC), the terminal stage of the disease. The addition of therapies beyond traditional ADT to achieve more sustained tumor regression by combining different mechanisms of action and targeting different cancer fuelling pathways has spurred the concept of treatment intensification in prostate cancer. This approach may involve the addition of androgen receptor pathway inhibitors (ARPIs) to ADT-hereafter referred to as "treatment intensification"-or the addition of ARPIs plus chemotherapy to ADT-hereafter referred to as "treatment optimization." Randomized controlled trials have consistently shown improved patient outcomes with the evolution from ADT alone to ADT plus ARPI, and more recently to ADT plus ARPI plus docetaxel, and demonstrated that treatment intensification decisions in mHSPC have clinically meaningful implications. However, in the absence of comparative efficacy data between therapy options, the treatment choice for a given patient will depend on patient- and disease-related factors, with the goal of improving outcomes while minimizing the cumulative toxicity of therapies, particularly when using combination strategies. In this article, a panel of 28 experts-8 urologists and 20 oncologists-with recognized experience and expertise in the management of advanced prostate cancer discussed the role of treatment intensification in mHSPC and which patients are more likely to benefit from each treatment strategy.
Source: Advances in Therapy
Authors: André Mansinho, João Carlos Gramaça, Rodrigo Ramos, Pedro Miguel Baltazar, José Palma dos Reis, Ricardo Fernandes, Mariana Malheiro, Alina Rosinha, Sofia Amorim, Ricardo Borges, Isaac Braga, Andreia Capela, Diogo Nunes Carneiro, Rui Dinis, André Ferreira, Arnaldo Figueiredo, Sílvia Lopes, Pedro Silvestre Madeira, Helena Magalhães, Hélder Mansinho, Sara Meireles, Carolina Pereira, Cidália Pinto, Chiara Rodrigues, Ana Spencer, Carolina Carvalho, Tiago Tomás, Carlos Rabaça
Institutions: Gulbenkian Institute for Molecular Medicine, Unidade Local de Saúde Santa Maria, Unidade Local de Saúde de São José, Unidade Local de Saúde do Arco Ribeirinho, Instituto Português de Oncologia Francisco Gentil, Hospital de São José, Universidade Nova de Lisboa, University of Lisbon, Clinical Academic Center of Braga, Unidade Local de Saúde de Braga, Comprehensive Health Research Centre, IPO Porto, Unidade Local de Saúde de Entre Douro e Vouga, Unidade Local de Saúde da Região de Leiria, Unidade Local de Saúde Gaia/Espinho, Unidade Local de Saúde de Santo António EPE, University of Évora, Hospital do Espírito Santo, Unidade Local de Saúde do Alentejo Central, Hospital de Santo André, Unidade Local de Saúde do Oeste, Unidade Local de Saúde de Coimbra, University of Coimbra, Instituto Português de Oncologia de Coimbra Francisco Gentil, Hospital Pedro Hispano, Unidade Local de Saúde de Matosinhos, Hospital Garcia de Orta, Unidade Local de Saúde de Almada-Seixal, Universidade do Porto, i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Unidade Local de Saúde do Algarve, Champalimaud Foundation, Hospital de Cascais Dr José de Almeida, Unidade Local de Saúde do Alto Ave, Hospital Prof. Dr. Fernando Fonseca, Hospital Cruz Vermelha, Unidade Local de Saúde de Amadora/Sintra, Unidade Local de Saúde do Médio Tejo
Language: English
Subfield: Pulmonary and Respiratory Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $4,790
OpenAlex ID: W7162196803