Navigating the Management of mCSPC From Mono to Quadruple Therapies

At the 36th Annual International Prostate Cancer Update, E. David Crawford, MD, Editor-in-Chief of Grand Rounds in Urology and Professor of Urology at the University of California, San Diego, San Diego, California, reviews the historical foundation of androgen deprivation therapy (ADT), including orchiectomy, estrogens, and luteinizing hormone–releasing hormone agonists. Early trials comparing leuprolide with diethylstilbestrol illustrate the limited design of early approval studies. Combined androgen blockade demonstrated a 26 percent survival improvement over monotherapy, yet debate over its value persisted for years. Contemporary practice now incorporates doublet regimens combining ADT with docetaxel or androgen receptor pathway inhibitors (ARPIs). Multiple randomized trials support improved overall survival and progression outcomes with these strategies. Triplet therapy integrating ADT, docetaxel, and an ARPI further improves outcomes in selected patients, particularly those with high-volume or de novo metastatic disease. Dr. Crawford introduces the concept of quadruple therapy, emphasizing that optimal care extends beyond tumor-directed intensification. Cardiovascular, skeletal, and metabolic complications of ADT require proactive, multidisciplinary management. Dr. Crawford underscores the dual priorities of survival extension and structured toxicity mitigation in modern mCSPC management. Don't forget to join the GRU Community: https://grandroundsinurology.com/regi... Follow us on Twitter/X: https://x.com/GRUrology And like and subscribe to us here on YouTube!