Pharmacological treatment landscape of non-metastatic hormone-sensitive prostate cancer: a narrative review on behalf of the Meet-URO Group

The definition of "non-metastatic hormone-sensitive prostate cancer" (nmHSPC) can be applied to patients with prostate cancer (PC) who are androgen-deprivation therapy-naïve and without evidence of metastatic disease. This definition includes heterogeneous situations; however, PC patients at high risk of metastatic spread - and who have not started a hormonal treatment - constitute a unique category with unmet clinical needs. This narrative review critically discusses the advances that characterize the rapidly evolving diagnostic and therapeutic scenario in the nmHSPC setting. We found that nmHSPC represents a grey zone in the context of PC. New clinical trials are trying to redefine the therapeutic algorithm of these patients, but escalating treatment seems not to be the right choice for the overall population. Biomarkers able to stratify patients - including molecular ones - are urgently needed, and biomarker-based clinical trials could clarify their prognostic and predictive role in the nmHSPC scenario.