For decades, the mainstay of treatment for metastatic hormone-sensitive prostate cancer has been androgen deprivation therapy. In recent years, 4 systemic therapies-docetaxel, abiraterone, enzalutamide, and apalutamide-have improved overall survival for men with metastatic hormone-sensitive prostate cancer when combined with androgen deprivation therapy, raising the question of which treatment to choose. The role for metastasis-directed therapy with surgery or radiation among these new treatments has also yet to be defined. Thus, several factors have come into play to guide treatment selection, including disease characteristics, age, fitness, and comorbidities of the patient, potential adverse effects of therapies, and health system considerations such as access to care and financial toxicity. Careful and shared decision making between patient and provider is critical. Future directions aimed at refining our treatment selection include researching the role of novel molecular imaging techniques, biomarkers predicting therapy response, sequencing and combining therapies, and understanding the long-term and late effects of these treatments.

中文翻译：

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指导激素敏感性转移性前列腺癌治疗选择的因素。

几十年来，治疗转移性激素敏感型前列腺癌的主要手段一直是雄激素剥夺疗法。近年来，与雄激素剥夺疗法联合使用时，4种全身疗法-多西他赛，阿比特龙，enzalutamide和apalutamide-改善了转移性激素敏感性前列腺癌男性的总体生存率，这带来了选择哪种治疗方法的问题。在这些新的治疗方法中，以外科手术或放射线进行的转移导向治疗的作用尚未确定。因此，有几种因素在指导治疗选择方面发挥作用，包括疾病的特征，患者的年龄，健康状况和合并症，治疗的潜在不良影响以及卫生系统的考虑因素，例如获得治疗和财务毒性。患者和提供者之间谨慎而共享的决策至关重要。旨在完善治疗选择的未来方向包括研究新型分子成像技术的作用，预测治疗反应的生物标志物，对治疗进行排序和组合以及了解这些治疗的长期和晚期效果。