(UroToday.com) The 2024 European Association of Urology (EAU) annual meeting featured a plenary session on personalized approaches in high-risk and metastatic prostate cancer, and a state of the art lecture by Dr. Karim Fizazi discussing how to personalize treatment in metastatic hormone sensitive prostate cancer (mHSPC). Dr. Fizazi started by emphasizing that yes, of course, the number of bone metastases has prognostic value. But, does counting bone metastases help with treatment decision making? Before 2023, common thoughts were that for low volume mHSPC there would be no use of docetaxel, utilization of ARPIs, and radiotherapy to the primary. For high volume mHSPC, patients would receive triplet systemic therapy (ADT + docetaxel + ARPI), with no radiotherapy to the primary tumor. Based on volume data from CHAARTED1 and STAMPEDE,2 there was clinical benefit to using docetaxel in high volume disease, however, in low volume disease there was a benefit in the STAMPEDE population but not in the CHAARTED cohort: