Journal: Clinical & translational oncology : official publication of the Federation of Spanish Oncology Societies and of the National Cancer Institute of Mexico
This narrative review focuses on treatment intensification for high‑risk non‑metastatic hormone‑sensitive prostate cancer (nmHSPC).
Key points:
- Context: Prostate cancer is the most common male malignancy; many patients have high‑risk features despite apparently localized disease and remain at substantial risk of biochemical recurrence and progression.
- Standard of care: Historically, management has relied on local therapy (radiotherapy or surgery) plus androgen deprivation therapy (ADT) in the nmHSPC setting.
- Rationale for intensification: Demonstrated survival benefits of adding androgen receptor pathway inhibitors (ARPIs) to ADT in metastatic hormone‑sensitive disease have prompted investigation of similar strategies in earlier, non‑metastatic high‑risk disease.
- Role of modern imaging: PSMA PET improves detection of occult metastatic disease and can alter staging and treatment selection, helping to distinguish truly non‑metastatic from low‑volume metastatic patients.
- Evidence base: Emerging data from randomized and phase II–III trials indicate that adding ARPIs to ADT in combination with radiotherapy, surgery, or salvage approaches can improve disease control in selected high‑risk nmHSPC populations.
- Conclusions: The review synthesizes current evidence supporting ARPI‑based intensification in nmHSPC and highlights how advances in systemic therapy and imaging are reshaping management, while emphasizing patient selection and integration with local treatments.