Compelling evidence has solidified the notion of early treatment intensification in managing patients with metastatic hormone-sensitive prostate cancer (mHSPC). Landmark trials have provided Level 1 evidence for the survival benefits achieved by combining multiple agents. The efficacy of combined therapy relies not only on how treatment is intensified but also on how it is de-escalated. This underscores the importance of tailored treatment approaches, potentially involving a reduction in therapy for specific patients, to strike a balance between the benefits of hormonal treatment and its associated adverse effects. While de-escalation of therapy in mHSPC remains challenging due to limited evidence, it is recommended for elderly or frail patients, those with poor performance status, or experiencing significant toxicity. However, for patients with excellent prostate-specific antigen responses or favourable biomarkers, decisions should be personalised, weighing the potential benefits of continued treatment against the risk of long-term side effects, using risk stratification tools where appropriate.
BJU international. 2025 Jan 02 [Epub ahead of print]
Bryan Chong, Marniza Saad, Tsung Wen Chong, John Thng, Yu Guang Tan, Kae Jack Tay, Christopher Cheng, Po-Hung Lin, Jeremy Teoh, Peter Ka-Fung Chiu, Nathan Lawrentschuk, Renu Eapen, Declan Murphy, Johan Chan, Melvin L K Chua, Jeffrey Tuan, John Yuen, Ravindran Kanesvaran, Kenneth Chen
Department of Urology, Singapore General Hospital, Singapore, Singapore., Department of Clinical Oncology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia., Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore., Department of Urology, Chang Gung Memorial Hospital Linkou, Taoyuan, Taiwan., Division of Urology, Department of Surgery, SH Ho Urology Centre, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China., Division of Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia., Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore., Division of Radiation Oncology, National Cancer Centre Singapore, Singapore, Singapore.