Metastatic Castration-Sensitive Prostate Cancer: Evolving Management With New Data from ASCO 2025

Petros Grivas, MD, PhD; Rana R. McKay, MD; Alicia Morgans, MD, MPH, and Neal Shore, MD, FACS discuss how to personalize treatment intensification in metastatic castration-sensitive prostate cancer by considering clinical factors like disease volume, patient fitness, genomic biomarkers, and emerging trial data to guide decisions between doublet versus triplet therapy regimens.

EP. 1: Personalizing Treatment Intensification in Metastatic Castration-Sensitive Prostate Cancer

June 30th 2025

Panelists discuss how clinical factors, including disease characteristics (Gleason score, volume, metastatic sites), patient factors (performance status, comorbidities, symptoms), and emerging genomic biomarkers, guide treatment intensification decisions in metastatic castration-sensitive prostate cancer.

EP. 2: Patient Fitness and the Doublet vs Triplet Debate in Metastatic Castration-Sensitive Prostate Cancer

June 30th 2025

Panelists discuss how medical comorbidities, physiologic vs chronologic age, drug interactions, and performance status influence the choice between doublet and triplet therapy regimens.

EP. 3: Choosing a Chemotherapy-Based Triplet Regimen in Metastatic Castration-Sensitive Prostate Cancer

July 9th 2025

Panelists discuss how the ARASENSE and PEACE-1 phase 3 trials demonstrated the efficacy of triplet therapy combining androgen deprivation therapy (ADT), docetaxel, and novel antiandrogens, while addressing the ongoing underutilization of intensified treatment approaches.

EP. 4: Emerging Trials and the Future of Biomarker-Driven Therapy in Metastatic Castration-Sensitive Prostate Cancer

July 9th 2025

Panelists discuss how emerging trials like AMPLITUDE (PARP inhibitors for BRCA mutations), PSMA-ADDITION (radioligand therapy), and CAPITELLO (AKT inhibitors for PTEN deficiency) are moving the field toward increasingly complex, biomarker-driven treatment selection.

EP. 5: Long-Term Efficacy of Doublets—the ARCHES 5-Year Update

July 16th 2025

Panelists discuss how the ARANOTE trial’s quality-of-life data and the ARCHES trial’s 5-year follow-up demonstrate sustained benefits of doublet therapy, with enzalutamide plus ADT showing a 3-year overall survival improvement in high-volume patients.

EP. 6: Interpreting ARANOTE: Darolutamide in Doublet and Triplet Therapy for Metastatic Castration-Sensitive Prostate Cancer

July 16th 2025

Panelists discuss how the ARANOTE trial’s progression-free survival benefits with darolutamide inform treatment selection between doublet and triplet approaches, emphasizing personalized decision-making based on tumor burden, patient performance status, and the “first shot, best shot” treatment philosophy.

EP. 7: Expert Perspectives: ARANOTE: Subgroup Analysis in Black Patients

July 23rd 2025

Panelists discuss how the ARANOTE trial’s subgroup analysis of 65 Black patients (primarily from Brazil and South Africa) demonstrated consistent treatment benefits and highlights the importance of diversity in clinical trials to address health care disparities and potential biological differences across populations.

EP. 8: Key Takeaways in mCSPC: Combination Therapy and Germline Testing Is the New Standard of Care

July 23rd 2025

Panelists discuss how androgen deprivation therapy (ADT) monotherapy is no longer acceptable for metastatic castration-sensitive prostate cancer (mCSPC), emphasizing that combination therapy with androgen receptor (AR) pathway inhibitors or chemotherapy plus universal germline testing should be the new standard of care.

EP. 9: PSA Nadir and Response Assessment in Metastatic Castration-Sensitive Prostate Cancer

July 30th 2025

Panelists discuss how prostate-specific antigen (PSA) nadir serves as a crucial prognostic marker in metastatic castration-sensitive prostate cancer (mCSPC), with faster drops to lower levels (particularly below 0.2) correlating with better outcomes, whereas imaging frequency should be customized based on clinical status and PSA kinetics.

EP. 10: Understanding PSA Threshold in Metastatic Castration-Sensitive Prostate Cancer

July 30th 2025

Panelists discuss how data from the International Registry for Men with Advanced Prostate Cancer (IRONMAN) demonstrates that achieving a prostate-specific antigen (PSA) threshold below 0.2 ng/mL at 6 to 12 months is associated with improved progression-free survival and overall survival regardless of treatment regimen.

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