Authored by Natalia Gandur, published on 2026-06-23 22:06:00.0
Confirm HRR-altered mCSPC treatment context
1. Confirm mCSPC
Metastatic castration-sensitive prostate cancer
2. Start / continue ADT
Androgen deprivation therapy
3. Obtain HRR testing
Germline and/or somatic testing for homologous recombination repair (HRR) alterations
4. HRR alteration present?
Yes
5. Assess suitability for talazoparib + enzalutamide + ADT
Performance status / functional status; Hematologic reserve (CBC, anemia, platelet count); Comorbidities and organ function (hepatic, renal); CNS history / seizure risk; Drug interactions and concomitant medications; Access / regulatory status / reimbursement; Ability to adhere and undergo monitoring
For HRR-altered mCSPC where supported by trial data, approval/access, and expert consensus
7. Monitor during therapy
CBC (anemia, neutropenia, thrombocytopenia); Fatigue, nausea, other AEs; Blood pressure, falls risk; PSA and imaging response; Adherence and quality of life
8. At progression
Reassess disease state → Consider next-line therapy, clinical trials, and supportive care
No
Use standard ARPI-based mCSPC pathway
Or other appropriate intensification strategy based on patient, disease, and access factors
7. Monitor during therapy
CBC (anemia, neutropenia, thrombocytopenia); Fatigue, nausea, other AEs; Blood pressure, falls risk; PSA and imaging response; Adherence and quality of life
8. At progression
Reassess disease state → Consider next-line therapy, clinical trials, and supportive care
No / Unknown
Follow standard mCSPC treatment pathway
Use guideline-recommended ARPI-based or other standard intensification strategies