The benefits of adding bone-protective agents, such as denosumab or bisphosphonates, to treatment in mHSPC are not yet certain. While some studies have shown no advantages, a nonstatistical trend toward improved bone progression-free survival was shown in one 2009 trial.
Subgroup analyses from the CHAARTED trial suggest that chemohormonal therapy may be most beneficial for men with mHSPC with a high-volume disease burden.
Radiation therapy to the primary tumor is associated with prolonged survival and a tolerable toxicity profile, and should therefore be considered in men with de novo low-volume mHSPC, per Boevé and colleagues. However, Parker and colleagues found that radiation therapy to the primary tumor does not appear to confer a survival benefit for men with de novo high-volume metastatic disease.
Radical prostatectomy in men with mHSPC in combination with optimal systemic therapy is one of a number of novel methods being evaluated in a clinical trial, but it should not be considered outside of a clinical trial. Numerous studies are enrolling patients with mHSPC worldwide and should be considered for all interested patients.
Access the Cancer of the Prostate: ESMO Clinical Practice Guidelines, The National Institute for Health and Care Excellence Guidance – Prostate Cancer: Diagnosis and Management, the Prostate Cancer Clinical Practice Guidelines of the National Comprehensive Cancer Network (NCCN), and the NCCN Guidelines Updates: Management of Prostate Cancer for recommendations for prostate cancer screening, diagnosis, and therapeutic strategies.
Learn more about treatment selection for patients with metastatic prostate cancer.
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Cite this: Bradley Schwartz, Daniel S. Schwartz. Fast Five Quiz: Metastatic Hormone-Sensitive Prostate Cancer Treatment - Medscape - Jun 27, 2022.