Management of Metastatic Prostate Cancer.

Background: Advanced stages of prostate cancer (PCa), in particular metastatic castration-resistant prostate cancer (mCRPC), are associated with significant morbidity and mortality. The androgen receptor (AR) signaling pathway is a cornerstone of therapeutic intervention, but resistance mechanisms and disease progression demand increasingly complex treatment strategies.

Methods: This narrative review is based on expert consensus, supported by a literature search in PubMed (MEDLINE) and the abstract databases of ASCO, ASCO GU and ESMO. Examples for novel treatment approaches were selected in order to illustrate current developments without claiming completeness.

Results: We provide a comprehensive overview on the management of metastatic PCa, highlighting the evolution of treatment approaches and their clinical implications. Androgen deprivation therapy (ADT) remains the backbone of therapy, enhanced by androgen synthesis inhibitors, AR inhibitors, and emerging AR degraders. Taxane-based chemotherapy, radiopharmaceuticals like radium-223 and lutetium-177 PSMA-617, and PARP inhibitors have expanded the therapeutic arsenal. Novel treatment approaches are in pre-clinical and clinical development. Various factors must be taken into account when deciding on the optimal treatment strategy including disease and patient specific aspects. In addition, previous treatment lines may impact the efficacy of subsequent therapeutic approaches.

Conclusion: The growing number of treatment options and a better understanding of the biological processes involved in tumor progression and the development of resistance are enabling increasingly individualized treatment of patients with advanced PCa.