{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,7]],"date-time":"2026-05-07T20:14:42Z","timestamp":1778184882074,"version":"3.51.4"},"reference-count":71,"publisher":"American Society of Clinical Oncology (ASCO)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Am Soc Clin Oncol Educ Book"],"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:sec>\n                    <jats:title\/>\n                    <jats:p>The therapeutic landscape of metastatic castration-resistant prostate cancer (mCRPC) has evolved substantially over the past decade, with androgen receptor pathway inhibitors, taxanes, poly (ADP-ribose) polymerase (PARP) inhibitors, radioisotopes, bone-protecting agents, and emerging targeted therapies improving survival for patients. At the same time, earlier treatment intensification in the hormone-sensitive setting has resulted in heterogeneous clinical presentations at the onset of castration resistance, adding complexity to treatment sequencing and clinical decision making. Here, we propose a pragmatic, patient-centered framework to help guide the management of mCRPC by integrating clinical features, molecular profiling, imaging findings, and supportive care considerations. Confirmation of castration resistance remains a critical first step and requires documented biochemical or radiographic progression in the setting of castrate testosterone levels. Treatment selection should consider prior systemic therapies, disease burden and tempo, symptom profile, comorbidities, and frailty. Molecular characterization, including evaluation for homologous recombination repair alterations and mismatch repair deficiency, is highly important for identifying candidates for PARP inhibitors or immune checkpoint blockade and other emerging biomarker-driven targeted strategies. Prostate-specific membrane antigen (PSMA)\u2013targeted radioligand therapy has emerged as a key treatment. PSMA-positron emission tomography\u2013based selection, incorporating assessment of uptake intensity, tumor heterogeneity, and total tumor volume, may help identify patients who are most likely to benefit from this treatment. Clinical factors such as liver metastases and limited prior response to androgen receptor\u2013directed therapy have been associated with less favorable outcomes. Early on-treatment assessment using prostate-specific antigen response and PSMA-based imaging may support adaptive treatment strategies and earlier recognition of resistance. Given the high prevalence of bone metastases, bone-protecting agents should be considered to reduce skeletal-related events. Early palliative care (EPC) is now widely recognized as a concurrent, patient-centered intervention that improves quality of life, symptom burden, coping, and satisfaction across advanced cancers. Prostate cancer represents an especially compelling setting for EPC because of prolonged advanced disease courses, cumulative symptom burden, repeated treatment transitions, and persistent unmet supportive needs.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1200\/edbk-26-516658","type":"journal-article","created":{"date-parts":[[2026,5,7]],"date-time":"2026-05-07T19:59:15Z","timestamp":1778183955000},"source":"Crossref","is-referenced-by-count":0,"title":["Optimizing Care for Patients With Metastatic Castration-Resistant Prostate Cancer"],"prefix":"10.1200","volume":"46","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-2890-1440","authenticated-orcid":false,"given":"Pierre-Yves","family":"Cren","sequence":"first","affiliation":[{"name":"Department of Medical Oncology, Centre Oscar Lambret, Lille, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"James","family":"Buteau","sequence":"additional","affiliation":[{"name":"Prostate Cancer Theranostics and Imaging Centre of Excellence (ProsTIC), Molecular Imaging and Therapeutic Nuclear Medicine, Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia"},{"name":"Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Umma","family":"Fatema","sequence":"additional","affiliation":[{"name":"Robert Wood Johnson Medical School, New Brunswick, NJ"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ronak","family":"Patel","sequence":"additional","affiliation":[{"name":"Robert Wood Johnson Medical School, New Brunswick, NJ"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3522-4579","authenticated-orcid":false,"given":"Biren","family":"Saraiya","sequence":"additional","affiliation":[{"name":"Robert Wood Johnson Medical School, New Brunswick, NJ"},{"name":"Rutgers Cancer Institute, New Brunswick, NJ"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4895-7384","authenticated-orcid":false,"given":"Louise","family":"Emmett","sequence":"additional","affiliation":[{"name":"Department of Theranostics and Nuclear Medicine, St Vincents Hospital Sydney, Darlinghurst, NSW, Australia"},{"name":"St Vincent's Clinical School University of New South Wales, Darlinghurst, NSW, Australia"},{"name":"Garvan Institute of Medical Research, Darlinghurst, NSW, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6068-9474","authenticated-orcid":false,"given":"Karim","family":"Fizazi","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Centre Oscar Lambret, Lille, France"},{"name":"University of Paris Saclay, Gif-sur-Yvette, France"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"233","reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.eururo.2024.09.017"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.annonc.2026.01.015"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1001294"},{"key":"e_1_3_2_5_2","article-title":"Trial design and objectives for patients with prostate cancer: Recommendations from the Prostate Cancer Working Group 4","author":"Armstrong AJ","year":"2026","unstructured":"Armstrong AJ, Morris MJ, Abida W, et al: Trial design and objectives for patients with prostate cancer: Recommendations from the Prostate Cancer Working Group 4. 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