• Axel S Merseburger, Laura-Maria Krabbe, Bernd Joachim Krause, Dirk Böhmer, Sven Perner, and AmsbergGunhild vonGV.
• Department of Urology, University Hospital Schleswig- Holstein, Campus Lübeck, Lübeck, Germany; University Hospital of Schleswig-Holstein, Campus Lübeck and Research Center Borstel, Leibniz Lung Center, Borstel, Germany; University Hospital Schleswig-Holstein, Campus Lübeck, Institute of Pathology, Lübeck, Germany; Department of Urology and Pediatric Urology, University Hospital Münster, Münster, Germany; Department of Nuclear Medicine, Rostock University Medical Center, Rostock, Germany; Department of Radiation Oncology and Radiation Therapy, Charité Universitäts - medizin - Campus Benjamin Franklin, Berlin, Germany; Department of Uro-Oncology of the Oncology Center and the Martini Clinic, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
• Dtsch Arztebl Int. 2022 Sep 16; 119 (37): 622632622-632.

BackgroundFor many years, the standard treatment of metastatic, hormone-sensitive prostatic carcinoma (mHSPC) was androgen deprivation therapy (ADT) alone. By lowering the testosterone level into the castration range, ADT deprives the tumor of a key growth factor.MethodsFor this article, we evaluated the treatment recommendations contained in national and international guidelines (German S3 guidelines and those of the European Society for Medical Oncology [ESMO], European Association of Urology [EAU], and National Comprehensive Cancer Network [NCCN]), as well as pertinent publications revealed by a PubMed search and the congress abstracts of the ESMO and of the American Society of Clinical Oncology [ASCO].ResultsThe past few years have witnessed fundamental changes in the treatment of mHSPC. Treatment intensification with docetaxel or with the new drugs directed against the androgen receptor signal pathway (abiraterone, apalutamide and enzalutamide) has been found to lower mortality by 19-40% and is now an integral component of first-line therapy. Relevant new findings have also been obtained with threefold combinations of ADT, docetaxel, and abiraterone or darolutamide. For patients with a light tumor burden, local radiotherapy of the primary tumor improves the probability of survival at 3 years by 8% (45.4 versus 49.1 months, difference 3.6 months; 95% confidence interval, 1.0 to 6.2 months).ConclusionThe treatment of mHSPC is constantly changing. Phase III trials that are now in the recruitment stage, as well as our continually improving understanding of the underlying molecular-pathological mechanisms, will be altering the treatment landscape still further in the years to come.

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