Survivorship Challenges in Metastatic Prostate Cancer in the Era of Prolonged Survival: A Review

In metastatic prostate cancer, there have been pronounced survival gains driven by the introduction of combination and intensification strategies. Consequently, many patients now experience prolonged survival with metastatic disease. While these advances represent a major therapeutic success, prolonged exposure to systemic therapies is associated with a broad spectrum of adverse effects. These side effects affect multiple domains, including bone health, cardiovascular risk, physical function, and psychological well-being. As a result, survivorship has emerged as a critical and increasingly relevant aspect of care in metastatic prostate cancer. In parallel, the importance of patient-reported outcomes in clinical trials, alongside traditional oncologic endpoints, is increasingly acknowledged. Overall, survivorship care in metastatic disease remains incompletely conceptualized as the long-term impact of cumulative treatment burden is often underrecognized. This narrative review examines key survivorship challenges in metastatic prostate cancer in an era of improving survival, with a focus on treatment-related toxicities, quality of life, and unmet needs in supportive care. We highlight current evidence, identify gaps in knowledge, and discuss future directions for integrating survivorship into routine clinical practice.