Unmet Needs and Key Takeaways for Community Oncologists

Oliver Sartor, MD, director of the Transformational Prostate Cancer Research Center at East Jefferson General Hospital in Metairie, Louisiana, reflects on the most pressing unresolved questions in the field of prostate cancer treatment and distills his key messages for community oncologists.
First, he identifies chemotherapy sequencing as a major area of ambiguity. While docetaxel has been a cornerstone of prostate cancer treatment since its FDA approval in 2004, and subsequent data confirmed its benefit when added to ADT in the hormone-sensitive setting, the landscape has shifted. With ARPIs now routinely used upfront, the critical open question is whether adding docetaxel to an ADT plus ARPI backbone provides additional benefit—a question the existing trials (ARCHES, PEACE-1) were not designed to answer, as they were built around adding an ARPI to an ADT plus docetaxel backbone.
Sartor also flags uncertainty around sequencing chemotherapy versus radiopharmaceuticals, citing a recent study suggesting that chemotherapy first might offer an advantage—but noting meaningful limitations in the trial design, including crossover imbalances in which lutetium was far more commonly used after docetaxel than vice versa. These data are hypothesis-generating but not yet practice-changing.
He closes with 2 overarching themes for community oncologists: first, the critical importance of genetic testing throughout the spectrum of advanced prostate cancer, reflecting both recent guideline changes and emerging data supporting earlier HRR testing. Second, the expanded and indispensable role of PSMA-PET imaging across multiple clinical scenarios. These themes—precision genomics and molecular imaging—represent the most transformative shifts in the 2026 guidelines and the practical foundation for delivering guideline-concordant, individualized prostate cancer care.