2023 expert consensus on decision pathway of metastatic hormone-sensitive prostate cancer management in Taiwan

This short communication presents a consensus-based expert opinion from a multidisciplinary team of Taiwanese experts in urology, medical oncology, and radiation oncology regarding the management of metastatic hormone-sensitive prostate cancer (mHSPC). Through a comprehensive review of recent clinical trials examining the efficacy of novel hormonal agents (NHAs) and docetaxel, alongside updated guidelines for mHSPC management, the experts have deliberated on the practical implications from currently available literatures. The discussion focused on the combination of androgen deprivation therapy, NHAs, and docetaxel, as reported in the leading studies including ARASENS (ODM-201 in Addition to Standard ADT and Docetaxel in Metastatic Castration Sensitive Prostate Cancer), ENZAMET (Enzalutamide in First Line Androgen Deprivation Therapy for Metastatic Prostate Cancer), and PEACE-1 (A Phase III Study for Patients with Metastatic Hormone naive Prostate Cancer) trial. The risk-benefit ratio between prolonged overall survival and the incidence of major adverse events was thoroughly evaluated. This consensus underscores the recommendation that early initiation of intensified triplet therapy with docetaxel, NHA, and androgen deprivation therapy is beneficial for fit mHSPC patients with highly aggressive disease characteristics, effectively prolonging overall survival with manageable risk of adverse events.