Novel biomarkers driving treatment selection in metastatic castration-sensitive prostate cancer: fundamentals of personalized clinical decision making

INTRODUCTION: Prostate cancer is well known to be androgen-dependent, with growth directly relying on the androgen receptor signaling pathway. In fact, androgen deprivation therapy, with or without Docetaxel and/or newer hormonal drugs such as Abiraterone acetate, Enzalutamide, Apalutamide, and Darolutamide, remains the most effective systemic treatment for metastatic disease. Beyond PSA detection, there is a lack of standardized biohumoral markers to understand the biology of metastatic castrate-sensitive prostate cancer (mCSPC), predict response to newer therapies such as immunotherapy, and identify a true oligometastatic state. AREAS COVERED: A comprehensive, non-systematic literature review across Scopus, Google Scholar, Medline, EMBASE, and the Cochrane Library was conducted. New evidence was identified, gathered, and screened for relevance, limited to English-language publications. Information and recommendations on the emerging mCSPC biomarkers, their possible integration, and application for care decisions were evaluated. Our work aimed to summarize the current understanding of molecular characterization of mCSPC and the evidence on the role of emerging molecular biomarkers in guiding personalized treatment for mCSPC. EXPERT OPINION: The integration of data extracted from imaging with the molecular and genetic profiles of a specific tissue, using artificial intelligence, will help assess the genetic and biochemical makeup of living tissue.