mHSPC stands for metastatic hormone-sensitive prostate cancer. It is a stage of advanced prostate cancer that has spread beyond the prostate to other parts of the body but still responds to treatment that lowers testosterone levels.
Key details regarding mHSPC from the sources include:
Terminology and Synonyms
- mCSPC: The terms metastatic castrate-sensitive prostate cancer (m1CSPC) and mHSPC are often used interchangeably in clinical practice and guidelines.
- ADT-naïve: It is also referred to as ADT-naïve disease, particularly in clinical trials like CHAARTED, because these patients have typically not yet started or are just beginning androgen deprivation therapy (ADT).
- Response to Treatment: The term “hormone-sensitive” or “castrate-sensitive” signifies that the cancer cells are still driven by androgens and can be effectively inhibited by lowering testosterone.
Clinical Presentation
- High-Volume vs. Low-Volume Disease: mHSPC is often categorized by the extent of the spread. High-volume disease is defined as having visceral metastases (spread to internal organs like the liver or lungs) and/or four or more bone metastases, with at least one spread beyond the pelvis or vertebral column.
- De-novo Metastatic Disease: This refers to patients who are diagnosed with metastatic disease at their initial presentation, rather than having the cancer return after local treatment.
Standard Treatment Approaches
Current guidelines recommend combining ADT with other systemic therapies rather than using ADT alone. Preferred Category 1 treatment options include:
- ADT + Novel Hormonal Therapies: Combinations with abiraterone, enzalutamide, or apalutamide.
- Triplet Therapy: For patients with high-volume disease, “triplet” regimens such as ADT + docetaxel + abiraterone or ADT + docetaxel + darolutamide are now recommended options.
- Radiation: In cases of low metastatic burden, External Beam Radiation Therapy (EBRT) to the primary tumor in combination with ADT may be considered.
Synonyms
mHSPC