Advanced and metastatic prostate cancer: Work-up and treatment strategy

Prostate cancer treatment relies on a multimodal approach based on the patient and disease characteristics. In this regard, imaging plays a crucial role in assessing cancer, whether it is for the initial evaluation or when recurrence occurs. Once it becomes metastatic (either at diagnosis or after curative treatment), castration, whether surgical or medical, used to be the sole treatment for these patients. However, since the introduction of chemotherapy with docetaxel and the emergence of next-generation hormone therapies such as abiraterone, enzalutamide, apalutamide and darolutamide, their survival has been significantly improved. In addition to these systemic treatments comes the possibility of irradiating the prostate tumor in patients with low-volume metastatic disease. After several months or years, these patients inevitably progress to the lethal form of the disease: castration-resistant prostate cancer. In this context, besides docetaxel, abiraterone, and enzalutamide, other treatments are also available, such as cabazitaxel, DNA repair-targeting agents like PARP inhibitors, radium-223, or more recently, Lu-PSMA. In some cases, a combination of treatments may also be considered. The objective of this review is to examine the role of imaging in the initial staging and metastatic recurrence work-up of prostate cancer, as well as the various therapeutic strategies for hormone-sensitive and castration-resistant metastatic prostate cancer. (C) 2023 Published by Elsevier Masson SAS.