Therapy Optimization in mHSPC: Insights from a Multidisciplinary Uro-Oncology Expert Panel

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.

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Publication Details

Journal
Advances in Therapy
Published
2026-05-23
DOI
https://doi.org/10.1007/s12325-026-03641-0
Primary Topic
Prostate Cancer Treatment and Research
Type
article
Field-Weighted Citation Impact
0.00

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article

Therapy Optimization in mHSPC: Insights from a Multidisciplinary Uro-Oncology Expert Panel

Rui Dinis, Isaac Braga, Arnaldo Figueiredo, Helena Magalhães et al.
Advances in Therapy
Prostate Cancer Treatment and Research
article

Therapy Optimization in mHSPC: Insights from a Multidisciplinary Uro-Oncology Expert Panel

Rui Dinis, Isaac Braga, Arnaldo Figueiredo, Helena Magalhães, Hélder Mansinho, Carlos Rabaça, Chiara Rodrigues, André Ferreira, Andreia Capela, P. Madeira, Pedro Baltazar, André Mansinho, José Palma dos Reis, Mariana Malheiro, Diogo Carneiro, Ricardo Fernandes, Carolina Pereira, Tiago Tomas, João Carlos Gramaça, Rodrigo Ramos, Sofia Amorim, Alina Rosinha, Carolina Carvalho, Cidália Pinto, Ricardo Borges, Ana Spencer, Sara Meireles, Sílvia Lopes
article en

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.

Advances in Therapy
Champalimaud Foundation (PT), University of Lisbon (PT), Instituto Politécnico de Leiria (PT), Instituto Português de Oncologia de Coimbra Francisco Gentil (PT), Universidade do Porto (PT), University of Évora (PT), Hospitais da Universidade de Coimbra (PT), Companhia União Fabril (PT), Unidade Local de Saúde de Entre Douro e Vouga (PT), Hospital de São José (PT), Escola Superior de Saúde da Cruz Vermelha Portuguesa (PT), Hospital Prof. Dr. Fernando Fonseca (PT), Osso (PT), Hospital Pedro Hispano (PT), Hospital do Espírito Santo (PT), Administração Regional de Saúde de Lisboa e Vale do Tejo (PT), IPO Porto (PT), Centro Hospitalar Lisboa Norte (PT), Algarve Biomedical Center (PT), Centro Hospitalar de Lisboa Ocidental (PT), Hospital de Santo António (PT), Hospital da Luz (PT), Centro de Medicina de Reabilitacao do Alcoitão (PT), Hospital Braga (PT), Centro Hospitalar de Vila Nova de Gaia (PT), United Nations University (PT), Hospital Garcia de Orta (PT), Instituto Português de Oncologia de Coimbra Francisco Gentil (PT), Hospital de Santa Maria (PT), i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto (PT), Unidade Hospitalar de Bragança (PT), Clinical Academic Center of Braga (PT), Cruz Vermelha Portuguesa, Instituto Gulbenkian de Ciência (PT), University of Coimbra (PT), Universidade Nova de Lisboa (PT)
Bristol-Myers Squibb, Pfizer, AstraZeneca, Les Laboratories Pierre Fabre, Incyte, Astellas Pharma, Universidade de Lisboa, Servier, Ipsen, Bayer Portugal, Fundação para a Ciência e a Tecnologia, Daiichi Sankyo Europe
Openalex Percentile: Top 5%
Prostate Cancer Treatment and Research
DOIOpen Access PDFOpenAlex
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