过去几年，转移性去势敏感型前列腺癌（mCSPC）的治疗取得了显着的突破。诊断和治疗的进步引起了关于风险分层和最佳一线治疗选择的争论，以及对具有高度异质性临床行为的疾病状态下潜在的过度治疗的担忧。在这里，我们使用实践中的病例报告来回顾探索将雄激素剥夺疗法与第二代雄激素受体信号抑制剂和多西他赛相结合的强化三联疗法的临床试验，并就如何最好地选择这些新型组合的候选者提供建议。此外，随着 PET 成像越来越多地采用越来越敏感的前列腺组织特异性示踪剂，取代了传统的分期技术，已导致识别出具有淋巴结转移的小体积 mCSPC 子集，否则根据 RECIST 标准，这些转移灶不会被视为异常。我们描述了针对这一具有不可测量的低容量 mCSPC 的独特人群的 PSA 适应治疗方法，该人群尚未在任何 III 期临床试验中进行专门研究。我们还讨论了正在进行的评估治疗降级策略的临床试验。最后，我们回顾了寡转移性 CSPC 中针对前列腺或远处疾病部位的局部治疗方式如何使患者受益，以及我们如何将转移导向治疗纳入 mCSPC 的治疗中。

The treatment of metastatic castration-sensitive prostate cancer (mCSPC) has seen remarkable breakthroughs over the last few years. Diagnostic and therapeutic advances have given rise to debates about risk stratification and optimal first-line treatment selection, as well as to concerns about potential overtreatment in a disease state with a highly heterogeneous clinical behavior. Here, we use case reports from our practice to review the clinical trials exploring intensified triplet regimens combining androgen deprivation therapy with second-generation androgen receptor signaling inhibitors and docetaxel, and we offer our recommendations on how to best select candidates for these novel combinations. Furthermore, the growing adoption of PET imaging with increasingly sensitive and prostate tissue-specific tracers replacing conventional staging technologies has led to the identification of a subset of low-volume mCSPC with nodal metastases which would otherwise not be considered abnormal by RECIST criteria. We describe our PSA-adapted approach to treatment in this unique population with non-measurable low-volume mCSPC which has not been specifically investigated in any phase III clinical trials. We also discuss ongoing clinical trials evaluating treatment de-escalation strategies. Finally, we review how local treatment modalities directed at the prostate or distant sites of disease in oligometastatic CSPC may benefit patients, and how we incorporate metastasis-directed therapy in the management of mCSPC.