The topic of metastatic castration-sensitive prostate cancer has been on the forefront of clinical research in prostate cancer for many years now.  In 2017, and again in 2019, I wrote Clinical Trials Portal articles on the topic of metastatic castration-sensitive prostate cancer, summarizing the key ongoing trials during those times.1, 2  We now know that early treatment intensification with the addition of either docetaxel, abiraterone acetate, enzalutamide or apalutamide to androgen deprivation therapy (ADT) offers a significant overall survival benefit.  Docetaxel is the only agent that may have questionable benefit for low volume metastatic prostate cancer, with benefit perhaps being restricted to high-volume metastatic disease only, defined as ≥4 bone metastases with at least one in the appendicular skeleton and/or a visceral metastasis.3

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