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This review explores four major controversies surrounding mHSPC management\u2014the role of prostate\u2010specific membrane antigen positron emission tomography scans as diagnostic imaging, triplet therapy (androgen deprivation therapy, androgen receptor pathway inhibitor, and docetaxel chemotherapy), radiation to the prostate and\/or oligo\u2010metastases, and bone modifying agents. Critical evaluation of the data emphasizes the need for further work to determine which subgroups of patients with mHSPC benefit from each treatment. 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