# Metastatic hormone-sensitive prostate cancer

Source: https://onco.cc/cancers/prostate-mhspc/  
OnCo record `prostate-mhspc` (Cancer). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Metastatic hormone-sensitive prostate cancer is disease that has spread but still responds to lowering testosterone. Hormone therapy alone is no longer enough: adding an androgen receptor inhibitor, and docetaxel for high-volume disease, lengthens life by years.

## Summary

Metastatic hormone-sensitive prostate cancer has spread to bone, nodes or organs and has not yet been exposed to, or is still controlled by, androgen deprivation. It is found by PSA, biopsy and imaging, increasingly PSMA PET, and is split into high volume (four or more bone metastases with one outside the spine and pelvis, or visceral disease) and low volume, and into de novo and recurrent disease. Androgen deprivation with a GnRH agonist or antagonist is the backbone. CHAARTED and STAMPEDE showed docetaxel added to it lengthens life, mainly in high-volume disease; LATITUDE and STAMPEDE showed the same for abiraterone; TITAN (apalutamide), ENZAMET and ARCHES (enzalutamide) and ARANOTE (darolutamide) extended the benefit to every androgen receptor pathway inhibitor. PEACE-1 and ARASENS proved triplet therapy with docetaxel plus abiraterone or darolutamide for men fit for chemotherapy with high-volume disease. Radiotherapy to the prostate improves survival in low-volume disease (STAMPEDE). CAPItello-281 added capivasertib for PTEN-deficient tumours in 2026, and PSMAddition brought 177Lu-PSMA-617 into this setting the same year. Hormone therapy alone is now reserved for frail men.

## Fields

- Kind: Cancer
- Last checked: 2026-09-25
- Also known as: mHSPC; Metastatic castration-sensitive prostate cancer; mCSPC; De novo metastatic prostate cancer; Hormone-naive metastatic prostate cancer; Hormone-sensitive prostate cancer
- Tags: subtype-page
- Group: genitourinary
- Burden: About one in twenty prostate cancers are metastatic at diagnosis in high-income countries and far more elsewhere; median survival has risen from under four years to more than five with combination therapy.
- Subtypes: De novo high-volume mHSPC (4 or more bone metastases or visceral disease); De novo low-volume mHSPC (oligometastatic, prostate radiotherapy helps); Recurrent metastatic hormone-sensitive disease after local therapy; PTEN-deficient mHSPC (capivasertib); PSMA-positive mHSPC (177Lu-PSMA-617)
- Biomarkers: Disease volume (CHAARTED criteria); De novo versus recurrent; PTEN loss by immunohistochemistry; PSMA PET positivity; Germline and tumour HRR genes; PSA fall to below 0.2 at seven months (prognostic)

## Sections of this record

The page is a hub with ten sections in reading order; large sections have their own page. The same plan as JSON: https://onco.cc/api/v1/cancers/prostate-mhspc/sections.json

- Overview (on the hub): The TL;DR, the family this cancer belongs to, the organ, who gets it and what the state of the art is. https://onco.cc/cancers/prostate-mhspc/#overview [3 state-of-the-art points]
- Types and stages (on the hub): Anatomy, the subtypes and how they differ, how it is staged, and where advanced disease spreads. https://onco.cc/cancers/prostate-mhspc/#what-it-is [5 subtypes]
- Symptoms and diagnosis (on the hub): How this cancer shows itself, how the diagnosis is confirmed, and the biomarkers clinicians test for. https://onco.cc/cancers/prostate-mhspc/#finding-it [6 biomarkers]
- Treatment (on the hub): The standard of care by setting, the medicines, surgery and radiotherapy named in it, and the regimens behind them. https://onco.cc/cancers/prostate-mhspc/#treating-it [5 settings, 5 decisions with options]
- Trials and papers (own page): Trials recruiting now, the landmark trials, the trials held by this cancer's subtypes, the key papers and what they mean, the latest literature, and the milestones year by year. https://onco.cc/cancers/prostate-mhspc/evidence/ [29 trials, 11 key papers, 8 milestones]
- Biology and targets (on the hub): The molecular landscape: the targets and how often each appears, the pathways, the mechanics stages and the preclinical models. https://onco.cc/cancers/prostate-mhspc/#science [5 targets]
- Countries and centres (own page): Cases by country, the UK and NHS pathway and other country lenses, the expert centres with trials on record, and the centres named on this cancer's subtypes. https://onco.cc/cancers/prostate-mhspc/where-you-are/ [1 centre, 26 UK centres]
- Decisions and support (on the hub): The decisions you may face, the aids that walk through them, the warnings on record, the first sixty days and the questions to ask. https://onco.cc/cancers/prostate-mhspc/#living-with-it [22 questions, 6 red cards]
- Pipeline and open problems (own page): Everything in development, the medicines held by this cancer's subtypes, the open problems and what is being done about them, the roadmaps, and what changed on this record. https://onco.cc/cancers/prostate-mhspc/coming/ [10 medicines, 29 trials, 3 ideas, 3 open problems]
- Data (own page): Every connected record, the notes, the JSON, Markdown and RDF twins, and where the record came from and when it was checked. https://onco.cc/cancers/prostate-mhspc/data/ [105 connected records, 1 note]

## Standard of care

- All patients, backbone: Continuous androgen deprivation with a GnRH agonist, GnRH antagonist or orchiectomy; never alone in fit men. ([Androgen deprivation & AR pathway inhibitors](https://onco.cc/technologies/androgen-deprivation/), [Leuprolide (leuprorelin) and GnRH agonists](https://onco.cc/drugs/leuprolide/), [Degarelix](https://onco.cc/drugs/degarelix/), [Relugolix](https://onco.cc/drugs/relugolix/), [Androgen deprivation therapy (ADT)](https://onco.cc/terms/adt/))
- Doublet therapy: Androgen deprivation plus abiraterone (LATITUDE, STAMPEDE), enzalutamide (ARCHES, ENZAMET), apalutamide (TITAN) or darolutamide (ARANOTE). ([Abiraterone acetate](https://onco.cc/drugs/abiraterone/), [Enzalutamide](https://onco.cc/drugs/enzalutamide/), [Apalutamide](https://onco.cc/drugs/apalutamide/), [Darolutamide](https://onco.cc/drugs/darolutamide/), [LATITUDE](https://onco.cc/trials/latitude/), [STAMPEDE](https://onco.cc/trials/stampede/), [ARCHES](https://onco.cc/trials/arches/))
- Triplet therapy, high volume, fit for chemotherapy: Androgen deprivation plus docetaxel plus darolutamide (ARASENS) or abiraterone (PEACE-1). ([Docetaxel](https://onco.cc/drugs/docetaxel/), [Darolutamide](https://onco.cc/drugs/darolutamide/), [Abiraterone acetate](https://onco.cc/drugs/abiraterone/), [ARASENS](https://onco.cc/trials/arasens/), [PEACE-1](https://onco.cc/trials/peace-1/), [CHAARTED (E3805)](https://onco.cc/trials/chaarted/))
- Low-volume disease: Doublet therapy plus radiotherapy to the prostate (STAMPEDE); metastasis-directed radiotherapy within trials. ([STAMPEDE](https://onco.cc/trials/stampede/), [IMRT / IGRT (modern external beam)](https://onco.cc/technologies/imrt-igrt/), [SBRT / SABR (stereotactic radiotherapy)](https://onco.cc/technologies/sbrt/), [Oligometastatic disease](https://onco.cc/terms/oligometastatic/))
- Biomarker-selected additions (2026): Capivasertib with abiraterone for PTEN-deficient tumours (CAPItello-281); 177Lu-PSMA-617 with androgen receptor pathway inhibitor for PSMA-positive disease (PSMAddition). ([Capivasertib](https://onco.cc/drugs/capivasertib/), [CAPItello-281](https://onco.cc/trials/capitello-281/), [Lutetium-177 vipivotide tetraxetan](https://onco.cc/drugs/pluvicto/), [PSMAddition](https://onco.cc/trials/psmaddition/))

## State of the art

- Combination therapy from diagnosis has lifted median survival past five years, and past eight in low-volume disease.
- Triplet therapy is standard for high-volume disease in men fit for docetaxel.
- The first biomarker-selected drugs, capivasertib and 177Lu-PSMA-617, entered this setting in 2026.

## Open problems

- Who needs triplet therapy and who is overtreated by it.
- Whether intermittent or de-escalated therapy is safe after a deep PSA response.
- PSMA PET restages many men the trials called non-metastatic, and the evidence has not caught up.

## Notes

- A word of caution about what stage IV means now. The ninth edition of TNM asks that a node or metastasis found on PSMA PET be written N1(PET) or M1(PET), because prostate is the malignancy most affected by stage migration: imaging now finds small-volume disease that older staging could not see, so a man diagnosed with metastatic disease on a PSMA PET may have much less cancer than a man given the same label before those scans existed, and the older survival figures were measured on the older label (Brierley 2026).

## Sources

- Wikipedia: https://en.wikipedia.org/wiki/Prostate_cancer#Metastatic_disease
- Wikipedia: https://en.wikipedia.org/wiki/Prostate_cancer
- NCCN Guidelines: Prostate Cancer: https://www.nccn.org/guidelines/guidelines-detail?category=1&id=1459
- Brierley et al., International Journal of Cancer 2026: the 9th edition of the UICC TNM classification of malignant tumours, updates and rationale for change (prostate at section 10.1): https://doi.org/10.1002/ijc.70561

## Connected records

- cancers: [Biochemical recurrence of prostate cancer](https://onco.cc/cancers/prostate-bcr/), [Ductal adenocarcinoma of the prostate](https://onco.cc/cancers/prostate-ductal-adenocarcinoma/), [Localised prostate cancer, high and very high risk](https://onco.cc/cancers/prostate-high-risk/), [Metastatic castration-resistant prostate cancer](https://onco.cc/cancers/prostate-mcrpc/), [Neuroendocrine and small-cell prostate cancer](https://onco.cc/cancers/prostate-nepc/), [Non-metastatic castration-resistant prostate cancer](https://onco.cc/cancers/prostate-nmcrpc/), [Prostate cancer](https://onco.cc/cancers/prostate/)
- terms: [Androgen deprivation therapy (ADT)](https://onco.cc/terms/adt/), [Cambridge Prognostic Group (CPG 1 to 5)](https://onco.cc/terms/cambridge-prognostic-group/), [Disease volume (CHAARTED high-volume versus low-volume) and LATITUDE risk](https://onco.cc/terms/disease-volume-chaarted/), [Genome-wide loss of heterozygosity (gLOH)](https://onco.cc/terms/genome-wide-loss-of-heterozygosity/), [Intermittent androgen deprivation (IAD)](https://onco.cc/terms/intermittent-androgen-deprivation/), [Metastasis-free survival (MFS)](https://onco.cc/terms/metastasis-free-survival/), [Oligometastatic disease](https://onco.cc/terms/oligometastatic/), [Other-cause mortality](https://onco.cc/terms/other-cause-mortality/), [Prostate cancer drugs in England: what NICE recommends, and what it refuses](https://onco.cc/terms/prostate-uk-drug-approvals/), [Prostate cancer programmes that failed, and what each failure taught](https://onco.cc/terms/prostate-failed-programmes/), [PTEN loss](https://onco.cc/terms/pten-loss/), [Radiographic progression-free survival (rPFS)](https://onco.cc/terms/radiographic-progression-free-survival/), [STAMPEDE's arms, and what each one answered](https://onco.cc/terms/prostate-stampede-arms/), [TNM staging for prostate cancer, and what changed in the 9th edition](https://onco.cc/terms/tnm-prostate-cancer/), [What androgen deprivation costs: the side of hormone therapy the survival curves do not show](https://onco.cc/terms/prostate-adt-burden/)
- trials: [A Phase III Clinical Study of Rezvilutamide in Patients With Metastatic Hormone-Sensitive Prostate Cancer](https://onco.cc/trials/nct07241416/), [A Study of Abemaciclib (LY2835219) With Abiraterone in Men With Prostate Cancer That Has Spread to Other Parts of the Body and is Expected to Respond to Hormonal Treatment (Metastatic Hormone-Sensitive Prostate Cancer)](https://onco.cc/trials/nct05288166/), [A Study of an Intermittent ADT Approach With Apalutamide Monotherapy in Participants With mCSPC](https://onco.cc/trials/nct05884398/), [A Study of Apalutamide (JNJ-56021927, ARN-509) Plus Androgen Deprivation Therapy (ADT) Versus ADT in Participants With mHSPC](https://onco.cc/trials/nct02489318/), [A Study of Niraparib in Combination With Abiraterone Acetate and Prednisone Versus Abiraterone Acetate and Prednisone for the Treatment of Participants With Deleterious Germline or Somatic Homologous Recombination Repair (HRR) Gene-MutatedProstatic Neoplasms (mCSPC)](https://onco.cc/trials/nct04497844/), [An Efficacy and Safety Study of Enzalutamide Plus Androgen Deprivation Therapy (ADT) Versus Placebo Plus ADT in Chinese Patients With Metastatic Hormo](https://onco.cc/trials/nct04076059/), [An Open-label Study of JSB462 (Luxdegalutamide) in Combination With Abiraterone in Adult Male Patients With Metastatic Hormone-sensitive Prostate Canc](https://onco.cc/trials/nct06991556/), [ARANOTE](https://onco.cc/trials/aranote/), [ARASENS](https://onco.cc/trials/arasens/), [ARCHES](https://onco.cc/trials/arches/), [CAPItello-281](https://onco.cc/trials/capitello-281/), [CHAARTED (E3805)](https://onco.cc/trials/chaarted/), [Combining EPI-7386 With Enzalutamide and Androgen Deprivation Therapy for Metastatic Hormone-Sensitive Prostate Cancer](https://onco.cc/trials/nct06312670/), [ENZAMET](https://onco.cc/trials/enzamet/), [GETUG-AFU 15](https://onco.cc/trials/getug-afu-15/), [HERO](https://onco.cc/trials/hero/), [KEYNOTE-991](https://onco.cc/trials/keynote-991/), [LATITUDE](https://onco.cc/trials/latitude/), [ORIOLE](https://onco.cc/trials/oriole/), [PATCH (Prostate Adenocarcinoma Transcutaneous Hormone)](https://onco.cc/trials/patch-transdermal-oestradiol/), [PEACE-1](https://onco.cc/trials/peace-1/), [PSMAddition](https://onco.cc/trials/psmaddition/), [Saruparib (AZD5305) vs Placebo in Men With Metastatic Castration-Sensitive Prostate Cancer Receiving Physician's Choice New Hormonal Agents](https://onco.cc/trials/nct06120491/), [STAMPEDE](https://onco.cc/trials/stampede/), [STOMP](https://onco.cc/trials/stomp-oligorecurrence/), [Study of Talazoparib With Enzalutamide in Men With DDR Gene Mutated mCSPC](https://onco.cc/trials/nct04821622/), [SWOG 9346 (intermittent androgen deprivation)](https://onco.cc/trials/swog-9346/), [This Study Will Explore Whether a Combination of the Investigational Drug Mevrometostat (PF-06821497) and Enzalutamide Will Work Better Than Taking En](https://onco.cc/trials/nct07028853/), [TulmiSTAR-02: A Phase I/II Open-label Study of Tulmimetostat in Combination With Darolutamide vs. Darolutamide, and Tulmimetostat With Abiraterone in ](https://onco.cc/trials/nct07190300/)
- key papers: [ARASENS: darolutamide added to androgen deprivation and docetaxel in metastatic hormone-sensitive prostate cancer](https://onco.cc/key-papers/paper-arasens-nejm-2022/), [CHAARTED: chemohormonal therapy in metastatic hormone-sensitive prostate cancer](https://onco.cc/key-papers/paper-chaarted-nejm-2015/), [GETUG-AFU 15: androgen deprivation alone or with docetaxel in non-castrate metastatic prostate cancer](https://onco.cc/key-papers/paper-gravis-getug-afu-15-docetaxel-lancet-oncol-2013/), [Huggins and Hodges 1941: the effect of castration, of oestrogen and of androgen injection on serum phosphatases in metastatic carcinoma of the prostate](https://onco.cc/key-papers/paper-huggins-hodges-castration-serum-phosphatases-prostate-1941/), [Inherited DNA-repair gene mutations in men with metastatic prostate cancer](https://onco.cc/key-papers/paper-pritchard-inherited-dna-repair-metastatic-prostate-nejm-2016/), [LATITUDE: abiraterone plus prednisone in newly diagnosed high-risk metastatic castration-sensitive prostate cancer](https://onco.cc/key-papers/paper-latitude-nejm-2017/), [Oncogenic genomic alterations, clinical phenotypes and outcomes in metastatic castration-sensitive prostate cancer](https://onco.cc/key-papers/paper-stopsack-mcspc-genomic-alterations-outcomes-ccr-2020/), [Prospective comprehensive genomic profiling of 3,476 primary and metastatic prostate tumours](https://onco.cc/key-papers/paper-chung-comprehensive-genomic-profiling-prostate-jco-po-2019/), [STAMPEDE: adding abiraterone to hormone therapy at diagnosis of advanced prostate cancer](https://onco.cc/key-papers/paper-stampede-abiraterone-nejm-2017/), [STOpCaP: docetaxel or bisphosphonates added to standard of care in hormone-sensitive prostate cancer, a systematic review and meta-analysis](https://onco.cc/key-papers/paper-vale-stopcap-docetaxel-bisphosphonates-lancet-oncol-2016/), [SWOG 9346: intermittent versus continuous androgen deprivation in metastatic prostate cancer](https://onco.cc/key-papers/paper-hussain-swog-9346-intermittent-androgen-deprivation-nejm-2013/)
- technologies: [Androgen deprivation & AR pathway inhibitors](https://onco.cc/technologies/androgen-deprivation/), [IMRT / IGRT (modern external beam)](https://onco.cc/technologies/imrt-igrt/), [PSMA PET](https://onco.cc/technologies/psma-pet/), [SBRT / SABR (stereotactic radiotherapy)](https://onco.cc/technologies/sbrt/)
- drugs: [Abiraterone acetate](https://onco.cc/drugs/abiraterone/), [Apalutamide](https://onco.cc/drugs/apalutamide/), [Capivasertib](https://onco.cc/drugs/capivasertib/), [Darolutamide](https://onco.cc/drugs/darolutamide/), [Degarelix](https://onco.cc/drugs/degarelix/), [Docetaxel](https://onco.cc/drugs/docetaxel/), [Enzalutamide](https://onco.cc/drugs/enzalutamide/), [Leuprolide (leuprorelin) and GnRH agonists](https://onco.cc/drugs/leuprolide/), [Lutetium-177 vipivotide tetraxetan](https://onco.cc/drugs/pluvicto/), [Relugolix](https://onco.cc/drugs/relugolix/)
- roadmaps: [Prostate cancer roadmap: from Huggins and the discovery that a cancer can depend on a hormone, through the PSA epidemic and what it cost, the androgen receptor drugs, the DNA repair subset and PSMA, to a 2032 registry watch](https://onco.cc/roadmaps/prostate-roadmap/)
- ideas: [Randomise the order of treatment, not only the drugs: a strategy platform for metastatic prostate cancer](https://onco.cc/ideas/idea-prostate-randomise-the-sequence-not-only-the-drugs/), [Report death from other causes as an outcome of the prostate cancer service, split by deprivation and ethnicity](https://onco.cc/ideas/idea-prostate-other-cause-mortality-as-a-reported-service-outcome/), [Test every man for DNA repair faults on the day his prostate cancer is found to have spread, not three treatments later](https://onco.cc/ideas/idea-prostate-hrr-testing-at-metastatic-diagnosis/)
- institutions: [Prostate Cancer UK](https://onco.cc/institutions/prostate-cancer-uk/)
- biomarkers: [AR amplification (gene and upstream enhancer)](https://onco.cc/biomarkers/ar-amplification/), [Homologous recombination repair gene mutation in prostate cancer](https://onco.cc/biomarkers/hrr-gene-mutation/), [PSMA expression by PET (PSMA-positive)](https://onco.cc/biomarkers/psma-pet-expression/), [PTEN alteration (sequencing) and PTEN loss (IHC)](https://onco.cc/biomarkers/pten-alteration/), [SPOP mutation](https://onco.cc/biomarkers/spop-mutation/)
- people: [Fred Saad](https://onco.cc/people/fred-saad/)
- targets: [PTEN](https://onco.cc/targets/pten/)
- companies: [MRC Clinical Trials Unit at UCL](https://onco.cc/companies/mrc-ctu/)

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JSON: https://onco.cc/api/v1/entities/prostate-mhspc.json