Metastatic Prostate Cancer

Authored by Axel Merseburger, published on 2026-04-21 23:27:39.0

Metastatic prostate cancer treatment algorithm outlining evidence-based therapy pathways between Hormone-Sensitive and Castration-Resistant prostate cancer. Reference diagram.

  1. Metastatic Prostate Cancer
    • Castration-Resistant
      • Continue ADT
        • ARPI: Abi/Enza/Daro/Apa PARPI: Olaparib/Rucaparib Docetaxel Radium-223 Lutetium-177 PSMA Immunotherapy
          • Best available option afterward: Clin Trial or switch to ARPI, Docetaxel, Cabazitaxel, or Lutetium-177 PSMA if not yet used
            • Consider adding Bone-Targeting Agent
    • Hormone-Sensitive
      Guidelines and pivotal trials support upfront systemic intensification for mHSPC with ADT plus ARPI and, in selected patients, docetaxel-based doublet or triplet regimens.
      • ADT + ARPI (Abi/Enza/Daro/Apa) or ADT + Docetaxel + Apa or Abi
        • Continue ADT + ARPI (Abi/Enza/Daro/Apa) Maintenance
          • Consider adding Bone- Targeting Agent
  2. Radiation Therapy of the Prostate in low volume (oligometastic) disease
tosprivacyAndrogen Deprivation Freezes Hormone-Sensitive Prostate Cancer Cells in a Reversible, Genetically Unstable Quasi-Apoptotic State, Bursting into Full Apoptosis upon Poly(ADP-ribose) Polymerase InhibitionCastration-Resistant Prostate Cancer: From Uncovered Resistance Mechanisms to Current Treatments