Current treatment options in hormonsensitive metastatic prostate cancer – individualised prostate cancer therapy

The incidence of prostate cancer shows an increasing trend worldwide, with > 1.2 million new cases of prostate cancer diagnosed annually. Thanks to the wide distribution and availability of screening tests, a significant part of them in developed countries is discovered at an early stage, in which treatment is carried out with a curative purpose. On the other hand, in metastatic patients, therapy aims to reduce symptoms, prolong survival, and maintain quality of life for as long as possible. In the metastatic stage, the treatment strategy is primarily determined by whether we are dealing with a hormone-sensitive or castration-resistant tumor. The therapeutic options for hormone-sensitive diseases have expanded significantly in the past decade. Until the mid-2010s, androgen deprivation therapy (ADT), which was the only treatment option, was replaced by double combinations, and more and more active agents already successfully used in castration-resistant tumors were found to improve survival in the hormone-sensitive phase when combined with ADT. Due to the favourable side effect profile and good tolerability of the new type of agents acting on the androgen receptor signalling pathway (ARSI), research has focused on the possibility of intensifying “doublet therapies” in the past few years. The results of clinical studies conducted with the so-called “triplet treatments” (docetaxel+ADT+ARSI) have been published, further expanding the therapeutic options for patients with hormone-sensitive metastatic prostate cancer and presenting new challenges to clinicians in choosing the optimal therapy. The purpose of this article is to review the available treatment options, summarize the results of clinical trials, and describe the most important subgroup analyses, which help practicing physicians implement personalized therapy in everyday practice.