Study aid only. Verify against current guidelines, primary literature, staging manuals, and prescribing information before clinical use.

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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 ↗