Optimizing First-Line Therapy in Metastatic Disease: From ARANOTE to Dose Adjustments in Practice

A regional roundtable discussion, moderated by Brian Myre, MD, Brian Moran Cancer Institute, examined the evolving landscape of prostate cancer management—from localized disease and salvage strategies to metastatic settings and future innovations in precision therapy. Dr. Myre was joined by other practitioners in the greater Chicago area, including Andrew Wiele, DO, Endeavor Health Cancer Institute; Ranko Miocinovic, MD, Brian Moran Cancer Institute; Amit R. Patel, MD, Brian Moran Cancer Institute; Ashley Ross, MD, PhD, Northwestern Feinberg School of Medicine; and Alan Wan, DO, Brian Moran Cancer Center. In the fourth segment, they discuss decision-making for first-line therapy in metastatic prostate cancer, focusing on how disease volume, imaging modalities, and patient frailty guide choices between ADT alone, doublets, or triplets. They also address side effect profiles, dosing adjustments, and practical considerations for geriatric patients, emphasizing personalized treatment based on tolerance and comorbidities.