# Metastatic hormone-sensitive prostate cancer

Source: https://onco.cc/cancers/prostate-mhspc/  
OnCo record `prostate-mhspc` (Cancer). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Metastatic hormone-sensitive prostate cancer is disease that has spread but still responds to lowering testosterone. Hormone therapy alone is no longer enough: adding an androgen receptor inhibitor, and docetaxel for high-volume disease, lengthens life by years.

## Summary

Metastatic hormone-sensitive prostate cancer has spread to bone, nodes or organs and has not yet been exposed to, or is still controlled by, androgen deprivation. It is found by PSA, biopsy and imaging, increasingly PSMA PET, and is split into high volume (four or more bone metastases with one outside the spine and pelvis, or visceral disease) and low volume, and into de novo and recurrent disease. Androgen deprivation with a GnRH agonist or antagonist is the backbone. CHAARTED and STAMPEDE showed docetaxel added to it lengthens life, mainly in high-volume disease; LATITUDE and STAMPEDE showed the same for abiraterone; TITAN (apalutamide), ENZAMET and ARCHES (enzalutamide) and ARANOTE (darolutamide) extended the benefit to every androgen receptor pathway inhibitor. PEACE-1 and ARASENS proved triplet therapy with docetaxel plus abiraterone or darolutamide for men fit for chemotherapy with high-volume disease. Radiotherapy to the prostate improves survival in low-volume disease (STAMPEDE). CAPItello-281 added capivasertib for PTEN-deficient tumours in 2026, and PSMAddition brought 177Lu-PSMA-617 into this setting the same year. Hormone therapy alone is now reserved for frail men.

## Fields

- Kind: Cancer
- Last checked: 2026-09-17
- Also known as: mHSPC; Metastatic castration-sensitive prostate cancer; mCSPC; De novo metastatic prostate cancer; Hormone-naive metastatic prostate cancer
- Tags: subtype-page
- Group: genitourinary
- Burden: About one in twenty prostate cancers are metastatic at diagnosis in high-income countries and far more elsewhere; median survival has risen from under four years to more than five with combination therapy.
- Subtypes: De novo high-volume mHSPC (4 or more bone metastases or visceral disease); De novo low-volume mHSPC (oligometastatic, prostate radiotherapy helps); Recurrent metastatic hormone-sensitive disease after local therapy; PTEN-deficient mHSPC (capivasertib); PSMA-positive mHSPC (177Lu-PSMA-617)
- Biomarkers: Disease volume (CHAARTED criteria); De novo versus recurrent; PTEN loss by immunohistochemistry; PSMA PET positivity; Germline and tumour HRR genes; PSA fall to below 0.2 at seven months (prognostic)

## Standard of care

- All patients, backbone: Continuous androgen deprivation with a GnRH agonist, GnRH antagonist or orchiectomy; never alone in fit men. ([Androgen deprivation & AR pathway inhibitors](https://onco.cc/technologies/androgen-deprivation/), [Leuprolide (leuprorelin) and GnRH agonists](https://onco.cc/drugs/leuprolide/), [Degarelix](https://onco.cc/drugs/degarelix/), [Relugolix](https://onco.cc/drugs/relugolix/), [Androgen deprivation therapy (ADT)](https://onco.cc/terms/adt/))
- Doublet therapy: Androgen deprivation plus abiraterone (LATITUDE, STAMPEDE), enzalutamide (ARCHES, ENZAMET), apalutamide (TITAN) or darolutamide (ARANOTE). ([Abiraterone acetate](https://onco.cc/drugs/abiraterone/), [Enzalutamide](https://onco.cc/drugs/enzalutamide/), [Apalutamide](https://onco.cc/drugs/apalutamide/), [Darolutamide](https://onco.cc/drugs/darolutamide/), [LATITUDE](https://onco.cc/trials/latitude/), [STAMPEDE](https://onco.cc/trials/stampede/), [ARCHES](https://onco.cc/trials/arches/))
- Triplet therapy, high volume, fit for chemotherapy: Androgen deprivation plus docetaxel plus darolutamide (ARASENS) or abiraterone (PEACE-1). ([Docetaxel](https://onco.cc/drugs/docetaxel/), [Darolutamide](https://onco.cc/drugs/darolutamide/), [Abiraterone acetate](https://onco.cc/drugs/abiraterone/), [ARASENS](https://onco.cc/trials/arasens/), [PEACE-1](https://onco.cc/trials/peace-1/), [CHAARTED (E3805)](https://onco.cc/trials/chaarted/))
- Low-volume disease: Doublet therapy plus radiotherapy to the prostate (STAMPEDE); metastasis-directed radiotherapy within trials. ([STAMPEDE](https://onco.cc/trials/stampede/), [IMRT / IGRT (modern external beam)](https://onco.cc/technologies/imrt-igrt/), [SBRT / SABR (stereotactic radiotherapy)](https://onco.cc/technologies/sbrt/), [Oligometastatic disease](https://onco.cc/terms/oligometastatic/))
- Biomarker-selected additions (2026): Capivasertib with abiraterone for PTEN-deficient tumours (CAPItello-281); 177Lu-PSMA-617 with androgen receptor pathway inhibitor for PSMA-positive disease (PSMAddition). ([Capivasertib](https://onco.cc/drugs/capivasertib/), [CAPItello-281](https://onco.cc/trials/capitello-281/), [Lutetium-177 vipivotide tetraxetan](https://onco.cc/drugs/pluvicto/), [PSMAddition](https://onco.cc/trials/psmaddition/))

## State of the art

- Combination therapy from diagnosis has lifted median survival past five years, and past eight in low-volume disease.
- Triplet therapy is standard for high-volume disease in men fit for docetaxel.
- The first biomarker-selected drugs, capivasertib and 177Lu-PSMA-617, entered this setting in 2026.

## Open problems

- Who needs triplet therapy and who is overtreated by it.
- Whether intermittent or de-escalated therapy is safe after a deep PSA response.
- PSMA PET restages many men the trials called non-metastatic, and the evidence has not caught up.

## Sources

- Wikipedia: https://en.wikipedia.org/wiki/Prostate_cancer#Metastatic_disease
- Wikipedia: https://en.wikipedia.org/wiki/Prostate_cancer
- NCCN Guidelines: Prostate Cancer: https://www.nccn.org/guidelines/guidelines-detail?category=1&id=1459

## Connected records

- technologies: [Androgen deprivation & AR pathway inhibitors](https://onco.cc/technologies/androgen-deprivation/), [IMRT / IGRT (modern external beam)](https://onco.cc/technologies/imrt-igrt/), [PSMA PET](https://onco.cc/technologies/psma-pet/), [SBRT / SABR (stereotactic radiotherapy)](https://onco.cc/technologies/sbrt/)
- trials: [ARASENS](https://onco.cc/trials/arasens/), [ARCHES](https://onco.cc/trials/arches/), [CAPItello-281](https://onco.cc/trials/capitello-281/), [CHAARTED (E3805)](https://onco.cc/trials/chaarted/), [LATITUDE](https://onco.cc/trials/latitude/), [PEACE-1](https://onco.cc/trials/peace-1/), [PSMAddition](https://onco.cc/trials/psmaddition/), [STAMPEDE](https://onco.cc/trials/stampede/)
- drugs: [Abiraterone acetate](https://onco.cc/drugs/abiraterone/), [Apalutamide](https://onco.cc/drugs/apalutamide/), [Capivasertib](https://onco.cc/drugs/capivasertib/), [Darolutamide](https://onco.cc/drugs/darolutamide/), [Degarelix](https://onco.cc/drugs/degarelix/), [Docetaxel](https://onco.cc/drugs/docetaxel/), [Enzalutamide](https://onco.cc/drugs/enzalutamide/), [Leuprolide (leuprorelin) and GnRH agonists](https://onco.cc/drugs/leuprolide/), [Lutetium-177 vipivotide tetraxetan](https://onco.cc/drugs/pluvicto/), [Relugolix](https://onco.cc/drugs/relugolix/)
- terms: [Androgen deprivation therapy (ADT)](https://onco.cc/terms/adt/), [Oligometastatic disease](https://onco.cc/terms/oligometastatic/)
- cancers: [Prostate cancer](https://onco.cc/cancers/prostate/)

---
JSON: https://onco.cc/api/v1/entities/prostate-mhspc.json