Avoiding Monotherapy: Any Progress?

How to cite: Hahn AW. “Avoiding Monotherapy: Any Progress?” February, 2026. Accessed Oct 2026. https://grandroundsinurology.com/avoiding-monotherapy-any-progress/

Summary

Andrew W. Hahn, MD, Assistant Professor of Genitourinary Medical Oncology, University of Texas, MD Anderson Cancer Center, Houston, Texas, reviews the role of androgen deprivation therapy (ADT) monotherapy in metastatic hormone-sensitive prostate cancer. He shares that the current standard of care is treatment intensification with ADT plus an androgen receptor pathway inhibitor (ARPI), with or without docetaxel in selected patients.

Dr. Hahn highlights that randomized clinical trials consistently demonstrate significant improvements in radiographic progression-free survival and overall survival when ARPIs are added to androgen deprivation therapy. These findings establish combination therapy as the minimum standard, and guideline recommendations no longer include ADT monotherapy for metastatic disease.

Despite this, real-world data previously suggested persistent use of ADT alone, particularly in earlier years following the introduction of combination therapy. He notes that these analyses are limited by missing variables and incomplete capture of more recent treatment patterns. More contemporary data demonstrate a decline in monotherapy use, although approximately one-third of patients were still receiving ADT alone as of recent analyses.

Dr. Hahn discusses factors associated with monotherapy use, including older age, comorbidities, treatment setting, and provider specialty. He emphasizes that these factors may influence treatment selection but should not automatically preclude intensification.

He reviews emerging data suggesting that the benefit of treatment intensification may vary in older patients, particularly with certain agents such as abiraterone, although these findings are exploratory and not definitive. Comorbidities, including cardiovascular disease and metabolic conditions, as well as potential germline predispositions, may influence toxicity and treatment tolerance.

Dr. Hahn concludes that ADT monotherapy has a very limited role in metastatic hormone-sensitive prostate cancer and that future research should focus on identifying patients who may benefit from de-escalated or tailored treatment approaches.

 

The International Prostate Cancer Update (IPCU), is a multi-day, CME-accredited conference focused on new developments in prostate cancer treatment, diagnosis, and prevention. IPCU 36 will feature lectures, interactive discussions, panel roundtables, debates, and case reports. This conference is led by expert physicians and is designed for urologists, medical oncologists, radiation oncologists, and other healthcare professionals involved in the diagnosis and treatment of prostate cancer.

The goal of this educational program is to equip healthcare professionals involved in the diagnosis and treatment of prostate cancer with the up-to-date clinical knowledge and tools they need to best treat their patients. The program will discuss the treatment of prostate cancer from diagnosis to treating advanced and metastatic disease. The conference aims to give physicians exposure to a comprehensive review of treating prostate cancer patients and to give them a chance to discuss the issues with peers and experts.