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mHSPC Treatment — RACP Adult Medicine MCQ

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ModerateMedical OncologymHSPC TreatmentRACP Adult Medicine

A 55-year-old man presents with lower back pain, raised ALP and PSA, and widespread sclerotic bone lesions on imaging. Prostate biopsy confirms Gleason 9 (4+5) adenocarcinoma. CT shows no visceral metastases. What initial hormonal treatment is indicated for metastatic hormone-sensitive prostate cancer?

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Correct answer: E — ADT plus abiraterone or enzalutamide

For metastatic hormone-sensitive prostate cancer (mHSPC), current standard of care is ADT (LHRH agonist/antagonist or surgical castration) PLUS one of: abiraterone + prednisolone, enzalutamide, apalutamide, or darolutamide (± docetaxel). Combination therapy significantly improves overall survival compared to ADT alone (LATITUDE, ENZAMET, TITAN, PEACE-1 trials). ADT alone is no longer considered optimal for de novo metastatic disease. Australian PCFA guidelines align with this approach.

Reference: Cancer Council Australia – 2023 – Prostate Cancer Guidelines; PCFA – 2024; ENZAMET Trial