{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T15:22:42Z","timestamp":1788189762471,"version":"build-2803163510"},"reference-count":41,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2025,8,5]],"date-time":"2025-08-05T00:00:00Z","timestamp":1754352000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Current Oncology"],"abstract":"<jats:p>The treatment landscape of metastatic hormone-sensitive prostate cancer (mHSPC) has transformed significantly with the advent of triplet therapy involving androgen deprivation therapy (ADT), docetaxel, and androgen receptor signalling inhibitors (ARSIs). While clinical guidelines increasingly support early intensification, real-world practice remains challenged by patient heterogeneity, evolving evidence, and limited consensus on treatment sequencing. This narrative review integrates evidence from landmark trials, clinical guidelines, and expert insights from oncologists managing mHSPC in India. Findings affirm that triplet therapy, particularly with darolutamide, improves survival in high-volume disease and underscores the need for personalized treatment based on disease burden, comorbidities, and genomic profiles. The review also highlights gaps in real-world data, sequencing strategies, and biomarker-driven therapy, reinforcing the need for precision medicine and locally relevant evidence to guide treatment. Ultimately, optimizing mHSPC management requires harmonizing guideline-based approaches with individualized, real-world decision making to improve patient outcomes.<\/jats:p>","DOI":"10.3390\/curroncol32080437","type":"journal-article","created":{"date-parts":[[2025,8,5]],"date-time":"2025-08-05T10:50:21Z","timestamp":1754391021000},"page":"437","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Evolving Treatment Paradigms in Metastatic Hormone-Sensitive Prostate Cancer: Expert Narrative Review"],"prefix":"10.3390","volume":"32","author":[{"given":"Vineet","family":"Talwar","sequence":"first","affiliation":[{"name":"Department of Medical Oncology, Rajiv Gandhi Cancer Institute and Research Centre (RGCIRC), New Delhi 110085, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kaushal","family":"Kalra","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, VMMC-Safdarjung Hospital, New Delhi 110029, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6006-2631","authenticated-orcid":false,"given":"Akhil","family":"Kapoor","sequence":"additional","affiliation":[{"name":"Mahamana Pandit Madanmohan Malaviya Cancer Centre and Homi Bhabha Cancer Hospital, Tata Memorial Centre, Homi Bhabha National Institute, Varanasi 221005, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P. S.","family":"Dattatreya","sequence":"additional","affiliation":[{"name":"Medical Oncology Services Renova Hospitals, Hyderabad 500034, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amit","family":"Joshi","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, ACTREC, Tata Memorial Centre, HBNI, Mumbai 410210, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Krishna","family":"Chaitanya","sequence":"additional","affiliation":[{"name":"Soumya Multispeciality Hospital, Hyderabad 500015, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4574-2599","authenticated-orcid":false,"given":"M. V.","family":"Chandrakanth","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Narayana Health, Kolkata 700016, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1934-8408","authenticated-orcid":false,"given":"Atul","family":"Batra","sequence":"additional","affiliation":[{"name":"Medical Oncology, Dr. B.R.A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences (AIIMS), New Delhi 110029, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Krishna","family":"Prasad","sequence":"additional","affiliation":[{"name":"Mangalore Institute of Oncology, Mangalore 575002, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nikhil","family":"Haridas","sequence":"additional","affiliation":[{"name":"Amrita Institute of Medical Sciences, Amrita Vishwavidyapeedam, Kochi Health Campus, Kochi 682041, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nilesh","family":"Lokeshwar","sequence":"additional","affiliation":[{"name":"MGM Hospital, Vashi 400703, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,8,5]]},"reference":[{"key":"ref_1","first-page":"209","article-title":"Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries","volume":"71","author":"Sung","year":"2021","journal-title":"CA Cancer J. 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