The first 60 days: 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. Below, week by week, is what OnCo's record of Metastatic hormone-sensitive prostate cancer says about the first two months: the order is typical, the timing is yours to ask about. Sections appear only where the record has something to say. Orientation, not medical advice.
What happens now
Staging tests establish exactly what and where the cancer is. Everything else follows from the answers.
Ask which of these were tested and what the results were; see the report reader for what each value means.
These specialties appear in the standard of care for this cancer. In most centres they meet weekly as a tumour board to agree each plan; you can ask when yours was discussed and what was decided.
- RadiologistNamed in the standard of care for: Biomarker-selected additions (2026).
- SurgeonNamed in the standard of care for: All patients, backbone.
- Medical oncologistNamed in the standard of care for: All patients, backbone, Doublet therapy, Triplet therapy, high volume, fit for chemotherapy, Low-volume disease and 1 more.
- Clinical oncologist (radiotherapy)Named in the standard of care for: Low-volume disease, Biomarker-selected additions (2026).
A second opinion from a centre that treats many similar cases is normal, not rude; the standard of care tells you what to compare it against.
Each row is a setting from the standard of care, in the order it usually arises. Not all will apply to you; your stage and biomarkers decide which do. The guideline grade, where recorded, says how strong the evidence is.
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).
Generated from this cancer's standard of care, biomarkers and open problems. Take the group that matches where you are. To tick, add your own and print, open the one-page appointment sheet.
Newly diagnosed
- What is my exact diagnosis, stage, and grade, and which tests established them?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?These results decide eligibility for targeted therapy, immunotherapy, and trials.
- Which subtype is my cancer, and does that change the recommended treatment?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?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?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?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?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?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?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?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?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?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?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?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?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?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?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?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?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?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?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?Open problems are where trials and second opinions matter most.
Much of what helps in the first weeks is free if you know to ask: testing, helplines, rides and lodging, second opinions, trial travel.
- Metastatic hormone-sensitive prostate cancer: the full pageMetastatic 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.
- One-page appointment sheetYour questions, the words you may hear, what to bring, and space for the answers. Print it.
- Treatment sequencingWhich treatment tends to follow which, line by line.
- NavigatorStandard of care for your stage, what you have tried, and trials near you.
- Androgen deprivation therapy (ADT): Switching off testosterone, the hormone that feeds prostate cancer, with injections (or tablets) that stop the testicles making it, or by removing them.
- Oligometastatic disease: Cancer that has spread to only a few places, which may still be curable by treating each spot.
Every term links to the glossary.