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Prostate Cancer — Systemic Therapy by Disease State
First-line
Second-line
SECOND-LINE
Prostate cancer
systemic therapy
by disease state
mHSPC
nmCRPC (M0)
mCRPC
Doublet
ADT + ARPI
TITAN / ARCHES ↗
Triplet
ADT + docetaxel + darolutamide
ARASENS ↗
Triplet
ADT + abiraterone + docetaxel
PEACE-1 ↗
ARPI
Apalutamide
SPARTAN ↗
ARPI
Enzalutamide
PROSPER ↗
ARPI
Darolutamide
ARAMIS ↗
ARPI
Abiraterone / enzalutamide
if not used earlier ↗
Taxane
Docetaxel → cabazitaxel
CARD ↗
PSMA
177Lu-PSMA-617
VISION ↗
HRR mut
PARP inhibitor
PROfound ↗
Bone-only
Radium-223
ALSYMPCA ↗
MSI-H
Pembrolizumab
dMMR / MSI-high ↗