This review explores the complexities of treatment intensification in metastatic hormone-sensitive prostate cancer (mHSPC), emphasizing the limitations of using disease volume and metastatic timing as sole prognostic factors. Current algorithms focus on clinical factors like ECOG, comorbidities, and patient preferences, yet lack biomarkers for more individualized therapy. By examining prognostic indicators - clinical, analytical, pathological, molecular, and imaging - this article highlights the importance of a personalized approach. Multimodal strategies and predictive biomarkers are proposed to optimize therapy selection between doublet and triplet regimens, ultimately improving patient outcomes. Future trials incorporating emerging biomarkers may provide the basis for precision treatment in mHSPC, shifting management beyond conventional classifications.
Future oncology (London, England). 2025 Mar 03 [Epub ahead of print]
Ángel Borque-Fernando, Teresa Alonso-Gordoa, María José Juan-Fita, Fernando Lopez Campos, Daniel Adolfo Pérez-Fentes, Antoni Vilaseca, Cristina Moretones Agut, Paola Usán, Pablo Maroto Rey
Urology Department, Hospital Universitario Miguel Servet, IIS-Aragón, Zaragoza, Spain., Medical Oncology Department, Hospital Universitario Ramón y Cajal, Madrid, Spain., Department of Medical Oncology, Fundación Instituto Valenciano de Oncología, Valencia, Spain., Radiation Oncology Department, Hospital Universitario Ramón y Cajal, Madrid. Genesis Care Hospital Vithas La Milagrosa, Madrid, Spain., Urology Department, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, A Coruña, Spain., Urology Department, Hospital Clínic de Barcelona, Barcelona, Spain., Medical Affairs Department, Bayer Hispania S.L, Barcelona, Spain., Oncology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.