Navigating systemic therapy for metastatic castration-naive prostate cancer

Introduction The last decade has seen a remarkable shift in the treatment landscape of advanced prostate cancer, none more so than in the management of metastatic castration-naive disease. Methods This narrative review will examine existing and emerging evidence supporting systemic therapy use for metastatic castration-naive prostate cancer (mCNPC) and provide guidance on the selection of these agents with respect to optimising patient outcomes. Results The addition of either docetaxel (chemohormonal approach) or an AR pathway inhibitor (abiraterone, enzalutamide or apalutamide) is a reasonable standard of care option for men commencing long-term ADT for mCNPC. While the issue of disease volume as a predictive biomarker for docetaxel benefit has previously been debated, recent data support consideration of upfront docetaxel in all patients, regardless of metastatic burden. Decisions regarding systemic treatment for men with mCNPC should be based on comprehensive consideration of disease, patient and logistical factors. Multiple novel therapeutics for mCNPC are currently under active investigation. Conclusion The introduction of potent systemic therapy earlier in the mCNPC disease course has resulted in dramatic improvements in clinical outcomes for patients. As the management of mCNPC continues to evolve, the future remains promising, with the expectation of ongoing improvements to patient outcomes and quality of life.

Automated summary

The management of metastatic castration-naive prostate cancer has drastically improved in the last decade due to the introduction of potent systemic therapies, with both chemohormonal approaches and AR pathway inhibitors showing promising results. Decision-making for treatment should take into consideration various factors and ongoing research into novel therapeutic options is expected to further enhance patient outcomes and quality of life.