A group of urologists from across the Dallas region convened for a recent Urology Times Clinical Forum moderated by Matthew L. Wilner, MD, of Urology Clinics of North Texas to discuss evolving approaches to managing metastatic castration-sensitive prostate cancer (mCSPC). The discussion focused on treatment selection, sequencing of therapies, and real-world factors affecting adoption of combination systemic therapy. Special attention was given to the integration of darolutamide (Nubeqa) into treatment paradigms and how clinicians weigh efficacy, tolerability, and patient characteristics when personalizing care.
Key Takeaways
- Treatment intensification with ARPIs and chemotherapy has transformed mCSPC management, expanding the urologist’s role in early treatment phases.
- Darolutamide is highlighted for its favorable safety profile, particularly its limited CNS penetration, making it suitable for patients prioritizing cognitive preservation.
- Real-world adoption of intensified therapies faces challenges, including cost, insurance barriers, and the need for multidisciplinary coordination.
- Genomic profiling and personalized care strategies are increasingly important for optimizing therapy selection and patient outcomes in mCSPC management.