Current diagnostic and therapeutic options in de novo low-volume metastatic hormone-sensitive prostate cancer

Introduction: de novo low-volume metastatic hormone-sensitive prostate cancer (mHSPC) patients are characterized by a limited number of metastases at diagnosis. Intensifying the current diagnostic and therapeutic approach including multimodality therapy seems to be key in the clinical management of such patients. Areas covered: We comprehensively review the current staging and treatment options for de novo low-volume mHSPC. Expert opinion: PSMA-PET should be used in staging high-risk prostate cancer to detect metastatic disease and better stratify patients for individualized treatment. In the era of Androgen Receptor Pathway Inhibitors (ARPIs), Androgen Deprivation Therapy (ADT) alone should be considered an undertreatment for the majority of the patients. Based on current data in the literature, the most effective therapeutic strategy seems to be the combination of intensified systemic treatment (including ADT + ARPI) and radiotherapy for the primary tumor. The role of cytoreductive radical prostatectomy is currently being investigated as well as metastasis-directed therapy to metastatic sites.