转移性去势抵抗性前列腺癌 (mCRPC) 的新疗法改善了患者的预后。然而，后续治疗方案的最佳治疗药物选择存在不确定性。我们对已发表的关键临床试验证据和最新的 mCRPC 治疗指南进行了全面审查。我们进一步确定了未来研究的知识和领域的差距。帮助指导 mCRPC 患者治疗选择的关键考虑因素包括个人治疗史、个体临床特征、症状、预后、临床试验的可用性和其他患者特异性因素。基因检测和前列腺特异性膜抗原靶向成像是评估新治疗方案候选资格的重要工具，例如聚（ADP-核糖）聚合酶抑制剂，单独或与雄激素受体途径抑制剂联合使用，以及[177Lu]Lu-PSMA- 617. 本文概述了不断发展的 mCRPC 治疗前景，讨论了指南推荐的治疗方案和关键临床试验的数据，同时强调了可能影响未来治疗前景的正在进行的试验。提供了基于个体患者因素的最佳治疗顺序的建议。© 2024。作者。

Novel therapies for metastatic castration-resistant prostate cancer (mCRPC) have improved patient outcomes. However, there is uncertainty on the optimal selection of therapeutic agents for subsequent lines of therapy.We conducted a comprehensive review of published evidence from pivotal clinical trials and recent guidelines for the treatment of mCRPC. We further identify gaps in knowledge and areas for future research.Key considerations to help guide treatment selection for patients with mCRPC include personal treatment history, individual clinical characteristics, symptoms, prognosis, availability of clinical trials, and other patient-specific factors. Genetic testing and prostate-specific membrane antigen-targeted imaging are important tools to evaluate candidacy for newer therapeutic options such as poly (ADP-ribose) polymerase inhibitors, alone or in combination with androgen receptor pathway inhibitors, and [177Lu]Lu-PSMA-617.This article provides an overview of the evolving treatment landscape of mCRPC, discussing guideline-recommended treatment options and data from key clinical trials, while highlighting ongoing trials that may impact the future treatment landscape. Recommendations for optimal treatment sequencing based on individual patient factors are provided.© 2024. The Author(s).