Metastatic hormone-sensitive prostate cancer
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.
Overview
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.
State of the art
- 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.
Show survival figures (1)
Averages across everyone diagnosed, often years ago. Your stage, subtype, age, fitness and the treatment you receive matter more than the average, and the numbers are improving quickly.
- Combination therapy from diagnosis has lifted median survival past five years, and past eight in low-volume disease.
Red cards
From the labels and guidelines behind the standard of care. Your team's thresholds win.- Emergency services nowBlood clot (tamoxifen and others)
A swollen painful calf, or sudden breathlessness with chest pain; the tamoxifen boxed warning covers pulmonary embolism and stroke.
- Emergency services nowBleeding or bruising
Bleeding that will not stop, black or bloody stools, or unexplained bruising when platelets are expected to be low.
- Emergency services nowBone pain flare or fracture (radium-223)
Sudden severe bone pain, or back pain with weakness or numbness in the legs (possible spinal cord compression).
- Check before combiningAbiraterone acetate with Apalutamide: major interaction
CYP3A4: Apalutamide (strong inducer) lowers Abiraterone exposure and may cause loss of efficacy.. Avoid strong inducers; if unavoidable, increase dosing frequency to twice daily during co-administration.
- Check before combiningAbiraterone acetate with Enzalutamide: major interaction
CYP3A4: Enzalutamide (strong inducer) lowers Abiraterone exposure and may cause loss of efficacy.. Avoid strong inducers; if unavoidable, increase dosing frequency to twice daily during co-administration.
- Check before combiningApalutamide with Enzalutamide: major interaction
CYP3A4: Enzalutamide (strong inducer) lowers Apalutamide exposure and may cause loss of efficacy.. Avoid strong inducers; if unavoidable, consider a dose increase per label and monitor response.
See all on the product pages:Abiraterone acetateApalutamideDarolutamideDegarelixDocetaxelEnzalutamideLeuprolide (leuprorelin) and GnRH agonistsLutetium-177 vipivotide tetraxetanRelugolix·Printable cards in the navigator
Anatomy and lymph node drainage
- Peripheral zone (most cancers)
- Transition zone (BPH)
- Ducts (ductal, intraductal, neuroendocrine)
- Seminal vesicle (T3b)
- Nodes: obturator
- Nodes: internal iliac
- Nodes: external iliac
- Nodes: presacral
About three quarters of cancers arise in the peripheral zone at the back of the gland, the part a finger or a biopsy needle reaches; drainage is to the obturator and iliac nodes.
- Peripheral zone (most cancers)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)
- Transition zone (BPH)
- Ducts (ductal, intraductal, neuroendocrine)
- Seminal vesicle (T3b)
- obturator
- internal iliac
- external iliac
- presacral
Same organ: Prostate cancer, Localised prostate cancer, very low and low risk, Localised prostate cancer, intermediate risk, Localised prostate cancer, high and very high risk, Biochemical recurrence of prostate cancer, Non-metastatic castration-resistant prostate cancer, Metastatic castration-resistant prostate cancer, Neuroendocrine and small-cell prostate cancer
Show survival figures (1)
Averages across everyone diagnosed, often years ago. Your stage, subtype, age, fitness and the treatment you receive matter more than the average, and the numbers are improving quickly.
- 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.
Cases by country
No country-level case numbers. This cancer is not mapped to a GLOBOCAN site.
One section per setting: the options named, what each is for, the trials behind them, the recorded trade-offs and the questions to ask.
Continuous androgen deprivation with a GnRH agonist, GnRH antagonist or orchiectomy; never alone in fit men.
Androgen deprivation plus abiraterone (LATITUDE, STAMPEDE), enzalutamide (ARCHES, ENZAMET), apalutamide (TITAN) or darolutamide (ARANOTE).
Androgen deprivation plus docetaxel plus darolutamide (ARASENS) or abiraterone (PEACE-1).
Doublet therapy plus radiotherapy to the prostate (STAMPEDE); metastasis-directed radiotherapy within trials.
Capivasertib with abiraterone for PTEN-deficient tumours (CAPItello-281); 177Lu-PSMA-617 with androgen receptor pathway inhibitor for PSMA-positive disease (PSMAddition).
Subtypes & biomarkers
top- 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)
- 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)
How often this target appears
- 1941Huggins shows castration controls metastatic prostate cancer
- 2015CHAARTED: docetaxel with hormone therapy lengthens life
- 2016STAMPEDE confirms docetaxel at first diagnosis
- 2017LATITUDE and STAMPEDE: abiraterone at first diagnosis
- 2019TITAN, ENZAMET and ARCHES: androgen receptor inhibitors for all
- 2021PEACE-1: European triplet therapy
- 2022ARASENS: darolutamide triplet cuts death by a third
- 2026Capivasertib for PTEN-deficient and 177Lu-PSMA-617 for PSMA-positive disease approved
Dated changes read from the records linked to this cancer: approvals, regulatory steps, reported trials, guideline versions and milestones. Newest first; no date is inferred.
All 23 changes by month →- 2026-09-17This recordMetastatic hormone-sensitive prostate cancerFacts on this page last checked
When this page itself was last checked or edited.
- 2026-07-31RegulatoryLutetium-177 vipivotide tetraxetanLutetium-177 vipivotide tetraxetan: approval (US)
PSMA+ metastatic hormone-sensitive prostate cancer with ARPI (PSMAddition)
- 2026MilestoneCAPItello-281Capivasertib for PTEN-deficient and 177Lu-PSMA-617 for PSMA-positive disease approved
A milestone in how this cancer is treated.
- 2025ApprovalDarolutamideDarolutamide approved in US
mHSPC with ADT alone (ARANOTE)
- 2025Trial resultCAPItello-281CAPItello-281 reported
rPFS significantly improved (HR reported at presentation); approved 2026.
- 2025Trial resultPSMAdditionPSMAddition reported
rPFS HR 0.
What is in development for Metastatic hormone-sensitive prostate cancer, drawn from the whole corpus: 8 items. Drugs are grouped by the most advanced trial phase they have reached anywhere; approved treatments sit under standard of care. Technologies are the methods being tested for this cancer, trials are the studies recorded here, and ideas are proposals not yet in a trial.
Trials reported · 8
- PSMAddition · phase 3 · 2025 · positive
- ARASENS · phase 3 · 2022 · positive
- ARCHES · phase 3 · 2019 · positive
- CAPItello-281 · phase 3 · 2025 · positive
- CHAARTED (E3805) · phase 3 · 2015 · positive
- LATITUDE · phase 3 · 2017 · positive
- PEACE-1 · phase 3 · 2021 · positive
- STAMPEDE · phase platform · 2016 · positive
Open problems and what is being done
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.
and how the field plans to fix it →What is being done about thisAdvanced and metastatic diseaseAvailable now- Abiraterone acetateApproved
- ApalutamideApproved
- DocetaxelApproved
- IMRT / IGRT (modern external beam)Standard of care
- Lutetium-177 vipivotide tetraxetanApproved
- PSMA PETStandard of care
In trials- ARCHESPositive
- CHAARTED (E3805)Positive
- LATITUDEPositive
- PSMAdditionPositive
- STAMPEDEPositive
Ideas and roadmapsNothing recorded yet.
Background: Oligometastatic disease. Also on OnCo: Atlas of advanced disease · Invasion and metastasis.
Trials
topTrials recruiting now
Country and place are remembered in this browser only. A postcode is sent to OpenStreetMap's Nominatim service to find coordinates when you press the button; nothing else leaves your device.
Landmark trials
Expert centres
topExpert centres
Villejuif · cancer center | France | none recorded | 1 | 1,855 | 31,182 | #6 | |
| United Kingdom | none recorded | 1 | 1,026 | 17,745 | #7 | ||
Melbourne · cancer center | Australia | none recorded | 0 | 1,547 | 24,196 | #14 | |
Stanford · university | United States | 0 | 3,000 | 50,162 | #30 | ||
Munich · university | Germany | none recorded | 0 | 1,937 | 23,450 | #31 | |
San Francisco · cancer center | United States | 0 | 2,800 | 46,704 | #33 | ||
London · hospital | United Kingdom | none recorded | 1 | 2,376 | 28,940 | - | |
| United Kingdom | none recorded | 1 | 641 | 10,459 | none recorded | - | |
London · consortium | United Kingdom | none recorded | 1 | not matched | - | none recorded | - |
Paris · consortium | France | none recorded | 1 | not matched | - | - | |
Los Angeles · cancer center | United States | 0 | 2,019 | 32,934 | - | ||
Dallas, TX · cancer center | United States | 0 | 1,744 | 19,757 | - | ||
Utrecht · cancer center | Netherlands | none recorded | 0 | 1,422 | 20,323 | - | |
Tianjin · cancer center | China | none recorded | 0 | 1,219 | 11,455 | - | |
Hangzhou · cancer center | China | none recorded | 0 | 1,219 | 17,635 | - |
These are the things we can measure; they are not a ranking of quality. Each column is a field on the institution record or a count over what OnCo has linked; a centre that treats many patients with Metastatic hormone-sensitive prostate cancer but is thinly recorded here will look small.
Not known: OnCo holds no case-volume or outcome figures for centres, so none are shown. Where a national audit or registry publishes them, the centre's page links to it. Default order: Newsweek rank, then trials for this cancer, then research output.
Questions to ask
topQuestions to ask your oncologist about Metastatic hormone-sensitive prostate cancer
Newly diagnosed
- What is my exact diagnosis, stage, and grade, and which tests established them?Why: Everything else follows from an accurate stage and subtype.
- Which biomarkers have been tested on my tumour (for example Disease volume, De novo versus recurrent, PTEN loss by immunohistochemistry, PSMA PET positivity, Germline and tumour HRR genes), and what were the results?Why: These results decide eligibility for targeted therapy, immunotherapy, and trials.
- Which subtype is my cancer, and does that change the recommended treatment?Why: Recognised subtypes for this cancer include De novo high-volume mHSPC, De novo low-volume mHSPC, Recurrent metastatic hormone-sensitive disease after local therapy.
- Is germline (inherited) genetic testing recommended for me or my family?Why: Inherited variants can change treatment and matter for relatives.
All patients, backbone
- For my situation (all patients, backbone), which of the standard options do you recommend and why?Why: Guideline options include: Continuous androgen deprivation with a GnRH agonist, GnRH antagonist or orchiectomy; never alone in fit men.
- Am I a candidate for Leuprolide (leuprorelin) and GnRH agonists, Degarelix, Relugolix, and what side effects should I expect?Why: Knowing the expected toxicities helps you plan work, family, and supportive care.
Doublet therapy
- For my situation (doublet therapy), which of the standard options do you recommend and why?Why: Guideline options include: Androgen deprivation plus abiraterone (LATITUDE, STAMPEDE), enzalutamide (ARCHES, ENZAMET), apalutamide (TITAN) or darolutamide (ARANOTE).
- Am I a candidate for Abiraterone acetate, Enzalutamide, Apalutamide or related drugs, and what side effects should I expect?Why: Knowing the expected toxicities helps you plan work, family, and supportive care.
- How do the results of LATITUDE and STAMPEDE apply to someone like me?Why: Trial populations differ from individual patients; ask how closely you match.
Triplet therapy, high volume, fit for chemotherapy
- For my situation (triplet therapy, high volume, fit for chemotherapy), which of the standard options do you recommend and why?Why: Guideline options include: Androgen deprivation plus docetaxel plus darolutamide (ARASENS) or abiraterone (PEACE-1).
- Am I a candidate for Docetaxel, Darolutamide, Abiraterone acetate, and what side effects should I expect?Why: Knowing the expected toxicities helps you plan work, family, and supportive care.
- How do the results of ARASENS and PEACE-1 apply to someone like me?Why: Trial populations differ from individual patients; ask how closely you match.
Low-volume disease
- For my situation (low-volume disease), which of the standard options do you recommend and why?Why: Guideline options include: Doublet therapy plus radiotherapy to the prostate (STAMPEDE); metastasis-directed radiotherapy within trials.
- How do the results of STAMPEDE apply to someone like me?Why: Trial populations differ from individual patients; ask how closely you match.
Biomarker-selected additions (2026)
- For my situation (biomarker-selected additions (2026)), which of the standard options do you recommend and why?Why: Guideline options include: Capivasertib with abiraterone for PTEN-deficient tumours (CAPItello-281); 177Lu-PSMA-617 with androgen receptor pathway inhibitor for PSMA-positive disease (PSMAddition).
- Am I a candidate for Capivasertib, Lutetium-177 vipivotide tetraxetan, and what side effects should I expect?Why: Knowing the expected toxicities helps you plan work, family, and supportive care.
- How do the results of CAPItello-281 and PSMAddition apply to someone like me?Why: Trial populations differ from individual patients; ask how closely you match.
Any stage
- Are there clinical trials I could join, for example of Capivasertib, Lutetium-177 vipivotide tetraxetan, PSMAddition, Relugolix?Why: Trials are how the next standard of care is set; asking early keeps options open.
- Would a second opinion at a high-volume centre change anything, and can you help arrange it?Why: Rare or high-stakes decisions benefit from a centre that treats many similar patients.
- What supportive care (symptom control, nutrition, exercise, mental health, financial help) is available from the start?Why: Supportive care improves quality of life and helps patients complete treatment.
- I read that “Who needs triplet therapy and who is overtreated by it”. How does that affect my plan?Why: Open problems are where trials and second opinions matter most.
- I read that “Whether intermittent or de-escalated therapy is safe after a deep PSA response”. How does that affect my plan?Why: Open problems are where trials and second opinions matter most.
Newly diagnosed? Read the first 60 days with Metastatic hormone-sensitive prostate cancer, then print the one-page appointment sheet with room for the answers.
Print this page for your appointment (your browser's print command). These prompts are for discussion; your clinical team knows your case.
Direct links plus the targets, companies, and technologies of this cancer's products.
technologies
9targets
4drugs
10companies
14terms
2trials
8Latest papers
topQuery for this cancer: (TITLE:"Metastatic hormone-sensitive prostate cancer" OR ABSTRACT:"Metastatic hormone-sensitive prostate cancer" OR TITLE:"mHSPC" OR ABSTRACT:"mHSPC" OR TITLE:"Metastatic castration-sensitive prostate cancer" OR ABSTRACT:"Metastatic castration-sensitive prostate cancer" OR TITLE:"mCSPC" OR ABSTRACT:"mCSPC" OR TITLE:"De novo metastatic prostate cancer" OR ABSTRACT:"De novo metastatic prostate cancer" OR TITLE:"Hormone-naive metastatic prostate cancer" OR ABSTRACT:"Hormone-naive metastatic prostate cancer") AND (treatment OR therapy OR trial OR survival OR diagnosis). Results are unfiltered search hits about Metastatic hormone-sensitive prostate cancer, not a curated reading list.
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