Personalized Treatment Decision-Making in Metastatic Castration-Resistant Prostate Cancer

Dr. Johann De Bono and Dr. Pedro Barata discuss the increasing complexity of personalized treatment decision-making in metastatic castration-resistant prostate cancer (mCRPC) as radiopharmaceutical and targeted treatment options continue to expand. Dr. Barata highlights the importance of integrating multiple clinical factors into treatment planning, including patient comorbidities, prior therapies, disease burden, metastatic distribution, PSMA expression, pathology, and molecular profiling. The faculty emphasize how genomic and imaging data are becoming increasingly important for selecting appropriate radiopharmaceutical approaches and optimizing sequencing strategies in mCRPC. The discussion also explores the growing number of emerging therapeutic targets beyond PSMA, including novel radioligand targets, antibody-drug conjugates, T-cell engagers, and additional targeted therapies that may further personalize care in the future. Together, the faculty underscore that treatment selection in mCRPC is becoming increasingly individualized, requiring integration of clinical judgment, biologic understanding, multidisciplinary collaboration, and evolving evidence to guide patient-centered decision-making in routine practice.