Personalizing Treatment Intensification in Metastatic Castration-Sensitive Prostate Cancer

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Leading oncology experts discuss the critical clinical factors that guide treatment decisions in metastatic castration-sensitive prostate cancer (mCSPC). Rana R. McKay, MD, emphasizes a multifaceted approach to treatment intensification, considering disease characteristics such as Gleason score, disease volume, and the presence of visceral metastases. Patient-specific factors, including performance status, comorbidities, cardiovascular health, and potential drug interactions, play equally important roles in determining optimal therapy selection.

The panel explores emerging genomic biomarkers that may predict treatment response, particularly focusing on decipher scores and P10 signatures that could guide docetaxel sensitivity. Although these molecular tools show promise in clinical trials like STAMPEDE, their clinical application remains under investigation. The discussion highlights the complexity of choosing between doublet therapy (androgen deprivation therapy plus novel antiandrogen) vs triplet therapy (adding docetaxel) based on individual patient profiles.

Treatment personalization in mCSPC requires careful consideration of multiple variables to optimize outcomes while minimizing toxicity. The experts stress that genomic testing may soon become standard practice for treatment selection, but current decisions must rely on established clinical and pathological factors. This comprehensive approach ensures patients receive the most appropriate therapy based on their unique disease characteristics and overall health status.