(UroToday.com) The phase 3 PEACE-1 began accruing in 2013, after which the therapeutic landscape of mCSPC has changed drastically. Initially, androgen deprivation therapy (ADT) alone was standard of care for castration-sensitive metastatic prostate cancer. However, in 2015, docetaxel was shown to improve survival. In 2017 the LATITUDE and STAMPEDE showed the survival advantage of the addition of abiraterone, and in 2019 two additional trials confirmed the advantage of adding the other anti-androgen pathway signaling inhibitors apalutamide and enzalutamide. Radiotherapy to the prostate for oligometastatic (low volume) disease has also been shown to improve overall survival.