Neeraj Agarwal, MD, FASCO

An expert highlights that the future of metastatic castration-resistant prostate cancer (mCRPC) treatment is advancing with novel drug classes such as radioligand therapies, proteolysis-targeting chimeras (PROTACs), T-cell engagers, and antibody-drug conjugates, all aimed at enhancing precision medicine through tumor sequencing to enable personalized, effective, and better-tolerated combination regimens that extend survival while preserving quality of life and patient independence.

An expert explains that metastatic castration-resistant prostate cancer (mCRPC) treatment is guided by prior therapies, disease features, and genetic profiles—favoring androgen receptor pathway inhibitors (ARPIs) for those without progression, PARP inhibitor combinations for patients with BRCA-mutated disease, and tailored options such as radium-223 for bone metastases or chemotherapy for aggressive, genetically altered tumors—with evolving strategies including radioligand therapies aimed at improving survival while preserving quality of life.

An expert emphasizes that treatment decisions for metastatic castration-resistant prostate cancer (mCRPC) are highly personalized, balancing clinical efficacy with patient lifestyle, quality of life, and preferences—prioritizing overall survival alongside minimizing adverse effects and hospital visits—while endorsing flexible treatment durations, including breaks and dose adjustments, to maintain both effectiveness and patient well-being through shared decision-making.

An expert highlights that safety considerations in metastatic castration-resistant prostate cancer (mCRPC) treatment depend on prior therapies and disease status, emphasizing early combination therapy for better control, vigilant bone health management with bone-modifying agents, proactive adverse effect mitigation, and the importance of exercise, nutrition, and cardiovascular monitoring to optimize patient outcomes and quality of life.

An expert emphasizes that genomic profiling—including both germline and somatic testing—is now essential in metastatic prostate cancer management because it identifies key mutations such as homologous recombination repair (HRR) gene alterations that guide targeted therapies such as PARP inhibitors, informs the use of immune checkpoint inhibitors in select cases, and helps predict disease aggressiveness to tailor monitoring and treatment strategies.

An expert discusses recent trial data showing that combining radium-223 with enzalutamide modestly improves outcomes in metastatic castration-resistant prostate cancer (mCRPC) with bone metastases—highlighting the necessity of bone-modifying agents to reduce fracture risk—while results from the TRITON3 trial underscore the greater efficacy of PARP inhibitors such as rucaparib when used early and in combination for BRCA-mutated patients.

An expert discusses how combining androgen receptor pathway inhibitors (ARPIs) with PARP inhibitors, particularly enzalutamide with talazoparib, has significantly improved outcomes in metastatic castration-resistant prostate cancer (mCRPC)—especially for patients with homologous recombination repair (HRR) mutations—underscoring the importance of early genomic testing and personalized combination therapy.

An expert discusses how treatment decisions in metastatic castration-resistant prostate cancer (mCRPC) increasingly depend on prior androgen receptor pathway inhibitor (ARPI) exposure, highlighting the need for individualized therapy sequencing based on evolving practice patterns and patient history.