mHSPC vs CRPC: Systemic Therapy Sequencing in Prostate Cancer

Two phases of metastatic disease

Metastatic hormone-sensitive prostate cancer (mHSPC) still responds to androgen deprivation. Castration-resistant prostate cancer (CRPC) progresses despite low testosterone, marking a later phase.

Sequencing principles

• mHSPC is treated with androgen deprivation plus a backbone such as a novel androgen-axis inhibitor or docetaxel.
• M0 CRPC (no metastases) uses agents that delay spread.
• M1 CRPC (metastatic) layers additional hormone-axis and chemotherapy options.

Staging role

M classification and serial imaging separate M0 from M1 and track transition between phases to time therapy changes.