mCRPC and mHSPC (castration-resistant vs hormone-sensitive prostate cancer)

Metastatic hormone-sensitive disease (mHSPC) is treated with androgen deprivation plus an ARPI (abiraterone, enzalutamide, apalutamide, darolutamide) and sometimes docetaxel (STAMPEDE, LATITUDE, ARASENS), which delays castration resistance by years. Castration-resistant disease (CRPC), defined by PSA or radiographic progression with testosterone <50 ng/dL, arises through androgen receptor amplification, mutations, splice variants (AR-V7) and intratumoural androgen synthesis; it is treated with ARPI switch, docetaxel and cabazitaxel, PARP inhibitors for HRR mutations, 177Lu-PSMA-617 (VISION, PSMAfore) and radium-223. Non-metastatic CRPC (rising PSA, clear scans) has its own approvals. Radiographic PFS (rPFS) is the usual endpoint.