Front-Line Therapeutic Strategy in Metastatic Hormone Sensitive Prostate Cancer: An Updated Therapeutic Algorithm.

Prostate carcinoma (PC), the second most diagnosed cancer globally, saw approximately 1,414,000 new cases in 2020, with 17% being de novo metastatic. In these cases, the 5-year relative survival rate is 32%. Metastatic hormone-sensitive prostate cancer (mHSPC) includes those with metastatic disease at initial diagnosis or after initial therapy without long-term androgen deprivation therapy (ADT), eventually progressing to castration-resistant prostate cancer (CRPC). The established therapeutic principle of ADT has persisted for 80 years, with luteinizing hormone-releasing hormone (LHRH) agonists like leuprorelin being commonly used. LHRH antagonists, such as degarelix, have also emerged. Recent advances in mHSPC treatment involve combination strategies with drugs proven effective in CRPC, considering prognostic factors like disease volume and presentation. This review outlines pivotal trials leading to drug approvals in mHSPC and proposes a treatment decision algorithm for the same, based on statement from the Tuscan Interdisciplinary Uro-Oncological Group. A multidisciplinary approach is crucial to tailor treatment intensity and weigh risks and benefits effectively.

Clinical genitourinary cancer. 2024 Apr 15 [Epub ahead of print]

Federico Paolieri, Enrico Sammarco, Marco Ferrari, Alessia Salfi, Adele Bonato, Debora Serafin, Natalia Coccia, Fiorella Manfredi, Luca Zatteri, Giovanni Dima, Chiara Carli, Rosanna Di Vita, Maria Oliveri, Laura Doni, Luca Galli, Michele Sisani, Martina Catalano, Giandomenico Roviello, Francesco Bloise

Department of Oncology, Hospital of Prato, Azienda USL Toscana Centro, Prato, Italy., Medical Oncology Unit, Livorno Hospital, Azienda Toscana Nord Ovest, Livorno, Italy., Medical Oncology Unit 2, Santa Chiara Hospital, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy., Medical Oncology Unit, Sant'Andrea Hospital, Azienda Sanitaria Locale 5 Spezzino, La Spezia, Italy., Clinical Oncology Unit, Careggi University Hospital, Florence, Italy., Medical Oncology Unit, San Donato Hospital, Azienda Toscana Sud Est, Arezzo, Italy., Department of Health Sciences, University of Florence, Florence, Italy. Electronic address: ., Department of Health Sciences, University of Florence, Florence, Italy.