Prostate Cancer Strategy: Why ‘More is More’ Isn’t Always the Best Approach

Choosing the best first-line treatment for metastatic hormone-sensitive prostate cancer (mHSPC) has become increasingly complex. To bring clarity, researchers conducted a large-scale network meta-analysis, a powerful technique that pools data from eleven randomised controlled trials to compare multiple treatments at once.

The study stratified patients by their disease volume (high or low) and the timing of metastasis—whether it appeared with the initial diagnosis (synchronous) or later (metachronous). The results provide compelling evidence for a more tailored strategy. For patients with high-volume, synchronous disease, aggressive 'triplet' therapies, which combine androgen-deprivation therapy (ADT) with an androgen receptor pathway inhibitor (ARPI) and docetaxel chemotherapy, offered the strongest survival benefits.

However, for those with low-volume disease, a two-drug 'doublet' of an ARPI plus ADT proved most effective. This landmark analysis offers a clearer roadmap for clinicians, demonstrating that treatment selection should be guided by the specific characteristics of an individual's cancer.