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.
Anatomy and lymph node drainage
- Peripheral zone (most indications)
- Transition zone (BPH)
- Ducts (ductal, intraductal, neuroendocrine)
- Seminal vesicle (T3b)
- Nodes: obturator
- Nodes: internal iliac
- Nodes: external iliac
- Nodes: presacral
About three quarters of indications 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 indications)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, 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.
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 indication: approvals, regulatory steps, reported trials, guideline versions and milestones. Newest first; no date is inferred.
All 16 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)
- 2026MilestonePSMAdditionCapivasertib for PTEN-deficient and 177Lu-PSMA-617 for PSMA-positive disease approved
A milestone in how this cancer is treated.
- 2025Trial resultPSMAdditionPSMAddition reported
rPFS HR 0.
- 2024Trial resultUpFrontPSMAUpFrontPSMA reported
41% undetectable PSA at 48 weeks with sequential 177Lu-PSMA-617 then docetaxel vs 16% with docetaxel alone (OR 3.
- 2022MilestoneMetastatic hormone-sensitive prostate cancerARASENS: darolutamide triplet cuts death by a third
A milestone in how this cancer is treated.
What is in development for Metastatic hormone-sensitive prostate cancer, drawn from the whole corpus: 4 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 under way · 1
- UpFrontPSMA · phase 2 · Peter MacCallum Cancer Centre / ANZUP Cancer Trials Group
Trials reported · 3
- PSMAddition · phase 3 · 2025 · positive
- CHAARTED (E3805) · phase 3 · 2015 · positive
- STAMPEDE · platform trial · 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.
What is being done about thisAdvanced and metastatic diseaseAvailable now- Abiraterone acetateApproved
- DocetaxelApproved
- Lutetium-177 vipivotide tetraxetanApproved
- PSMA PETStandard of care
In trials- CHAARTED (E3805)Positive
- PSMAdditionPositive
- STAMPEDEPositive
- UpFrontPSMAActive
Ideas and roadmapsNothing recorded yet.
Background: Oligometastatic disease. Also on Nuclide: Indications.
Trials
topTrials recruiting now
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Landmark trials
Direct links plus the targets, companies, and technologies of this cancer's products.
isotopes
1fronts
1technologies
2targets
1drugs
4companies
3terms
1trials
4Latest papers
topQuery for this indication: (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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