Oliver Sartor, MD

Chemotherapy sequencing in the ARPI era and the role of radiopharmaceuticals versus docetaxel remain unsettled, while genetics and PSMA-PET emerge as essential themes for community oncologists.

Radium-223 retains a role in osteoblastic bone-only disease, while PSMA PET has become indispensable across staging, recurrence detection, and patient selection for radioligand therapy.

Bone-only, osteoblastic disease and the absence of prior ARPI exposure define the optimal radium-223 candidate, while sequencing relative to lutetium-177 PSMA-617 remains an active area of investigation.

The mCRPC section's reorganization by prior treatment exposure reflects how ARPI and docetaxel use in the hormone-sensitive setting now defines—and constrains—options in the castration-resistant phase.

Collapsing the very-low-risk category reflects broader acceptance of active surveillance for Gleason 6 disease, while PARP inhibitor eligibility now requires genetic testing at the hormone-sensitive stage.

New FDA approvals and emerging trial data drive two pivotal 2026 NCCN guideline updates: lutetium-177 PSMA-617 for taxane-naive mCRPC and PARP inhibitors in the hormone-sensitive setting.