Prostate cancer treatment has evolved from general hormone therapy to a personalized “ABCs + D” approach. While localized prostate cancer has a high 5-year survival rate, the focus is now on metastatic castration-resistant prostate cancer (mCRPC), which has historically had poor outcomes. Modern care emphasizes intensifying treatment earlier to achieve deeper responses.
The “ABCs + D” framework includes androgen receptor pathway inhibitors (A), biomarker-driven and bone-targeted therapies (B), chemotherapy (C), and emerging targeted drugs (D). Recent breakthroughs in the “D” category include antibody-drug conjugates like ifinatamab deruxtecan, which delivers chemotherapy directly to cancer cells, showing up to 33% response in patients with liver metastases.
Other promising therapies include T-cell engagers like Xaluritamig and Pasritamig, AR degraders and steroidogenesis inhibitors such as BMS-986365 and opevesostat, and epigenetic modifiers like mevrometostat. These innovations aim to directly kill cancer cells, boost the immune system, or make resistant tumors sensitive to hormone therapy again, offering new hope for patients with advanced prostate cancer.