Personalizing Care Improves Outcomes in Metastatic Prostate Cancer

For patients living with metastatic hormone-sensitive prostate cancer (mHSPC), a more personalized approach to treatment and supportive care is helping improve outcomes and quality of life. According to findings presented by Dr. Tanya Dorff at the 19th Annual New York GU Cancers Congress®, optimizing therapy selection based on individual health factors, combined with proactive supportive care, can make a meaningful difference throughout the disease journey.

Dorff is division chief of the Genitourinary Disease Program and a professor in the Department of Medical Oncology & Therapeutics Research at City of Hope.

Most patients with mHSPC benefit from combination, or doublet, therapy, although some may be candidates for more intensive triplet approaches. However, experts also emphasize that treatment decisions should consider not only cancer characteristics, but also comorbidities, life expectancy and lifestyle.

Beyond treatment itself, exercise, cardiovascular health management and side effect support play a critical role in helping patients stay on therapy and maintain well-being.

Most patients benefit from combination therapy

Evidence shows that many patients with mHSPC benefit from androgen receptor pathway inhibitor (ARPI)-based treatment strategies. These therapies improve progression-free survival across multiple clinical trials, although their impact may be somewhat reduced in older patients, particularly with certain agents such as abiraterone.

Doublet therapy remains the standard for most individuals, although triplet therapy (which adds chemotherapy or other agents) may be appropriate for select patients, especially those with high-volume disease. Emerging research is also exploring biomarker-driven triplet strategies. For example, studies evaluating combinations such as abiraterone with targeted therapies like PARP inhibitors or AKT inhibitors have shown improvements in radiographic progression-free survival, although these regimens may come with increased side effects.

Importantly, not all patients are candidates for every therapy. Preexisting conditions, such as cardiovascular disease or neurologic risks, may influence treatment selection. For instance, certain therapies may not be suitable for patients with a history of seizures or stroke, emphasizing the importance of individualized care.

Biomarkers and prognostic indicators continue to evolve

Although researchers are investigating biomarkers to guide treatment decisions in mHSPC, these tools are not yet ready for routine clinical use. Early findings suggest that genetic alterations, such as homologous recombination repair (HRR) mutations, may help identify patients who benefit most from targeted therapies. However, further validation is needed.

One prognostic marker already showing clinical relevance is prostate-specific antigen (PSA) response. Patients whose PSA levels do not fall below 0.2 ng/mL within approximately seven months of starting therapy tend to have poorer overall survival outcomes. Ongoing clinical trials are exploring whether these patients may benefit from treatment intensification strategies, such as switching to triplet therapy.

Other studies are evaluating the role of advanced imaging and targeted radiation approaches, although results remain mixed. For example, treating the primary prostate tumor with radiation has shown improvement in progression-free survival, but not overall survival, highlighting the complexity of treatment decision-making.

A shift toward personalized care

Historically, treatment for metastatic prostate cancer relied heavily on androgen deprivation therapy (ADT) alone. Over time, research has demonstrated that combining ADT with additional agents significantly improves outcomes, leading to the current emphasis on doublet and triplet strategies.

At the same time, there is growing recognition that survivorship care is equally important. Long-term ADT is associated with side effects such as metabolic changes, cardiovascular risks, bone loss and cognitive effects. Addressing these issues proactively is now considered a key component of comprehensive cancer care.

Trials such as LATITUDE, STAMPEDE, TITAN and others have contributed to the current understanding of how ARPI-based therapies perform across different subgroups. In addition, ongoing studies are investigating newer combinations and biomarker-driven approaches in more selected patient populations.

Additional findings highlight importance of lifestyle and supportive care

Beyond drug therapy, supportive care plays a critical role in improving both survival and quality of life. Exercise, in particular, stands out as one of the most impactful interventions patients can adopt. Research suggests that regular physical activity, including both cardiovascular and resistance training, is associated with improved survival and better overall quality of life. Experts recommend aiming for approximately 225 minutes of moderate exercise per week.

Managing cardiovascular risk factors is another essential component of care. Monitoring and controlling blood pressure, cholesterol and blood sugar levels may help reduce the risk of serious complications associated with long-term ADT.

Patients may also experience side effects such as hot flashes, fatigue, cognitive changes and sexual dysfunction. Addressing these issues early and proactively can help patients remain on treatment longer and maintain daily functioning.

Dietary choices may also play a role, with some studies suggesting that plant-based diets are associated with improved outcomes, potentially through cardiovascular benefits.

A collaborative approach to care

Ultimately, optimizing outcomes in mHSPC requires a strong partnership between patients and their care teams. As treatment options continue to expand, shared decision-making becomes increasingly important. Patients are encouraged to stay engaged in their care, adopt healthy lifestyle habits and work closely with both oncologists and primary care providers to manage overall health.

References

1. “Optimizing Outcomes in mHSPC: Patient Selection, Supportive Care, and Survivorship,” by Dr. Tanya Dorff. Presented at: 19th Annual New York GU Cancers Congress®.

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