Treating De Novo Metastatic Castration-Sensitive Prostate Cancer With Visceral Metastases: An Evolving Issue

Visceral metastasis is widely considered a prognostic factor for overall survival of men with metastatic castration-sensitive prostate cancer (mCSPC) and has been historically managed with androgen deprivation therapy (ADT). More recently, this therapeutic scenario has been enriched by the possibility to integrate ADT with chemotherapy or novel androgen-signalling–targeted inhibitors. In order to define the effect of chemotherapy/androgen-signalling–targeted inhibitors plus ADT, we performed a pooled analysis on patients with mCSPC and visceral metastases revealing that survival was significantly improved in patients without visceral metastasis (HR=0.64 95%CI: 0.56-0.74; p<0.01) compared with men with visceral metastases (HR=0.68; 95%CI: 0.51-0.91; p<0.01). Although several limitations do not allow to draw definitive conclusions, our analysis confirms the efficacy of chemotherapy/androgen-signalling–targeted inhibitors in combination with ADT also in mCSPC with visceral metastases. In the absence of specific randomized controlled trials, symptoms, toxicity, cost, patients’ preference and clinical experience should guide the decision to add chemotherapy or androgen receptor-targeted therapy to ADT in patients with visceral metastases from mCSPC.