Targeted choice among treatment options for metastatic hormone-sensitive prostate cancer

Since 1944, when Huggins and Hodges demonstrated the effectiveness of bilateral orchiectomy for metastatic prostate cancer (PCa), androgen deprivation therapy (ADT) has become the first-line treatment for men with advanced PCa. The proportion of metastatic PCa cases at diagnosis ranges globally, from 5% - 20% in countries with widespread screening practices to 30% - 60% in countries with insufficient screening. In the Russian Federation, 44 706 new cases of PCa were diagnosed in 2019, of them approximately 19% were metastatic. Ongoing discussions on prostate- specific antigen (PSA) screening practices, increased access to novel imaging modalities, and a globally aging population will impact the detection rate of metastatic hormone-sensitive prostate cancer (mHSPC). At the same time, advances in the study of combined hormonal or chemohormonal therapy have led to a significant change in the treatment paradigm. In this article, we review recent advances in treatment choices for men with newly diagnosed mHSPC and the impact of prior therapy on the subsequent biology of the disease. Options include treatment with chemohormonal therapy, androgen receptor (AR)-directed therapy in addition to ADT, or, less commonly, ADT alone. Treatment choice should include consideration of the clinical characteristics and characteristics of the disease, as well as patient preferences, geographical limitations, and cost-effectiveness of medications.