Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Oncol. Feb 24, 2021; 12(2): 43-49
Published online Feb 24, 2021. doi: 10.5306/wjco.v12.i2.43
Metastatic hormone-sensitive prostate cancer: How should it be treated?
Fernando López-Campos, Carmen González-San Segundo, Antonio José Conde-Moreno, Felipe Couñago
Fernando López-Campos, Department of Radiation Oncology, Hospital Universitario Ramón y Cajal, Madrid 28034, Spain
Carmen González-San Segundo, Department of Radiation Oncology, HGU Gregorio Marañon, Complutense University, Madrid 28007, Spain
Antonio José Conde-Moreno, Department of Radiation Oncology, Hospital Universitario y Politécnico La Fe. CEU Cardenal Herrera University, Valencia 46026, Spain
Felipe Couñago, Department of Radiation Oncology, Hospital Universitario Quirón Salud Madrid, Hospital La Luz, Universidad Europea de Madrid (UEM), Madrid 28223, Spain
Author contributions: All the authors contributed equally to designing and performing this research and have read and approve the final manuscript.
Conflict-of-interest statement: Authors declare no conflict of interests for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Felipe Couñago, MD, PhD, Professor, Department of Radiation Oncology, Hospital Universitario Quirón Salud Madrid, Hospital La Luz, Universidad Europea de Madrid (UEM), Calle Diego de Velázquez, 1, 28223 Pozuelo de Alarcón, Madrid 28223, Spain. fcounago@gmail.com
Received: September 27, 2020
Peer-review started: September 27, 2020
First decision: January 7, 2021
Revised: January 7, 2021
Accepted: January 26, 2021
Article in press: January 26, 2021
Published online: February 24, 2021

The number of treatment options for metastatic hormone-sensitive prostate cancer has increased substantially in recent years. The classic treatment approach for these patients—androgen-deprivation therapy alone—is now considered suboptimal. Several randomized phase III clinical trials have demonstrated significant clinical benefits—including significantly better overall survival and quality of life—for treatments that combine androgen-deprivation therapy with docetaxel, abiraterone acetate, enzalutamide, apalutamide, and/or radiotherapy to the primary tumour. As a result, these approaches are now included in treatment guidelines and considered standard of care. However, the different treatment strategies have not been directly compared, and thus treatment selection remains at the discretion of the individual physician or, ideally, a multidisciplinary team. Given the range of available treatment approaches with varying toxicity profiles, treatment selection should be individualized based on the patient’s clinical characteristics and preferences, which implies active patient participation in the decision-making process. In the present document, we discuss the changing landscape of the management of patients with metastatic hormone-sensitive prostate cancer in the context of several recently-published landmark randomized trials. In addition, we discuss several unresolved issues, including the optimal sequencing of systemic treatments and the incorporation of local treatment of the primary tumour and metastases.

Keywords: Metastatic hormone-sensitive prostate cancer, Androgen-receptor signaling inhibitors, Abiraterone acetate, Enzalutamide, Apalutamide, Docetaxel

Core Tip: Due to advances in the treatment of metastatic hormone-sensitive prostate cancer in recent years, multiple options are now available. The emergence of androgen receptor inhibitors provides patients with an alternative to chemotherapy. Given the increasingly important role of these novel treatments, a comprehensive review of the available data is needed. In addition, there are several unresolved questions and controversies surrounding these treatments, which can only be resolved by in-depth analysis and consensus among the specialists who treat these patients.