Future Landscape in High-risk Prostate Cancer and Metastatic Prostate Cancer

Abstract

Summary The management of high-risk and advanced prostate cancer had a major paradigm shift over the past decade. From the Huggins’ era of sole androgen deprivation therapy (ADT), the management has evolved to novel androgen receptor signaling inhibitors (ARSI), chemotherapy, targeted molecular, immunotherapy, and radiotheranostics. The management of advanced prostate cancer is broadly studied under metastatic hormone or castration-sensitive prostate cancer (mCSPC) or metastatic castration-resistant prostate cancer (mCRPC). The mCSPC has evolved from mere ADT to the use of abiraterone, enzalutamide, and docetaxel-based chemotherapy and the burning conflict of treatment intensification with triplet therapy. Various novel agents, such as poly (ADP-ribose) polymerase inhibitors (PARPIs) and radiotheranostics, are being explored in the management of mCSPC. The management of mCRPC has evolved from mitoxantrone to docetaxel-based therapy, novel ARSI therapy, PARPI, 177 lutetium-prostate-specific membrane antigen-617, or novel-targeted therapy.