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The Oncology Grand Rounds series is designed to place original reports published in the Journal into clinical context. A case presentation is followed by a description of diagnostic and management challenges, a review of the relevant literature, and a summary of the authors' suggested management approaches.

The goal of this series is to help readers better understand how to apply the results of key studies, including those published in Journal of Clinical Oncology, to patients seen in their own clinical practice.

The standard of care for treatment of men with metastatic hormone-sensitive prostate cancer (mHSPC) is combination treatment with androgen deprivation therapy (ADT) plus docetaxel or an androgen receptor signaling inhibitor (ARSI), with triplet therapy (ADT plus docetaxel plus an ARSI) considered for patients with high-volume disease who are fit and have a preference to intensify treatment.

ADT alone is no longer a standard outside of use for select populations with a limited life expectancy, contraindications, or personal preferences that make intensification a poor option. To choose between these options, the initial evaluation and plan for treatment of men with mHSPC includes an assessment of patient and cancer-related factors, as well as factors associated with each treatment option.

Deciding between treatment options also requires characterizing the extent and location of metastatic disease and understanding differences in expected efficacy and adverse event rates, administration and monitoring schedules and patient-facing costs.

Only by approaching each patient from the perspective of guiding them to the best combination option first and reflexing to ADT monotherapy as an option when no intensification strategy is possible, can we ensure that all patients have access to treatment that is expected to provide the best disease control and quality of life in this setting.

Read an interview about the study here.