Metastatic prostate cancer in the genomic era: Guideline-concordant strategies for diagnosis, treatment, and survivorship

Metastatic prostate cancer (PCa) remains a leading cause of cancer-related morbidity and mortality for men in the United States. This review synthesizes current approaches to the diagnosis, treatment, and survivorship of men with metastatic hormone-sensitive and castration-resistant PCa (mCRPC). With evolving systemic therapies, expanded access to radioligand treatments, and the integration of genomic profiling, oncology care is shifting toward individualized management strategies. Germline and somatic testing, particularly BRCA1/2 and other homologous recombination repair genes, are now guideline recommended to inform prognosis, therapeutic selection, and cascade testing of at-risk family members. However, despite consensus guidelines, underuse of genetic testing persists, leaving critical opportunities for precision therapy and familial risk reduction unmet. Nurse practitioners (NPs), positioned at the intersection of clinical care and patient education, play a pivotal role in ensuring guideline-concordant genomic testing, interpreting and communicating results, and supporting patients and families through complex health care decisions.