Gonzalez Del Alba, AMendez-Vidal, M JVazquez, SCastro, ECliment, M AGallardo, EGonzalez-Billalabeitia, ELorente, DMaroto, J PArranz, J A2023-02-092023-02-092021-01-27http://hdl.handle.net/10668/17228The treatment of advanced prostate cancer has evolved due to recent advances in molecular research and new drug development. Dynamic aberrations in the androgen receptor, DNA repair genes, PTEN-PI3K, and other pathways drive the behavior of advanced prostate cancer allowing a better selection of therapies in each patient. Tumor testing for BRCA1 and BRCA2 is recommended for patients with metastatic prostate cancer, also considering a broad panel to guide decisions and genetic counseling. In symptomatic metastatic patients, castration should be stared to palliate symptoms and prolong survival. In high-risk or high-volume metastatic hormone-naïve patients, castration should be combined with docetaxel, abiraterone, enzalutamide or apalutamide. Radiotherapy to the primary tumor combined with systemic therapy is recommended in low-volume mHNPC patients. In patients with non-metastatic castration-resistant tumors, risk stratification can define the frequency of imaging. Adding enzalutamide, darolutamide or apalutamide to these patients prolongs metastasis-free and overall survival, but potential adverse events need to be taken into consideration. The choice of docetaxel, abiraterone or enzalutamide for treating metastatic castration-resistant patients depends on previous therapies, with cabazitaxel being also recommended after docetaxel. Olaparib is recommended in BRCA1/BRCA2 mutated castration-resistant patients after progression on at least one new hormonal therapy. Aggressive variants of prostate cancer respond to platinum-based chemotherapy. To optimize treatment efficiency, oncologists should incorporate all of these advances into an overall therapeutic strategy.enAttribution 4.0 Internationalhttp://creativecommons.org/licenses/by/4.0/AndrogenBiomarkersCastrationMolecularResearchAndrogen antagonistsAndrostenesAntineoplastic agentsBenzamidesCombined modality therapyDocetaxelGenes, BRCA1Genes, BRCA2Genetic testingHumansMaleMedical oncologyNitrilesOrchiectomyPhenylthiohydantoinPhthalazinesPiperazinesProstatic neoplasmsProstatic neoplasms, castration-resistantRadiotherapyRandomized controlled trials as topicSocieties, medicalSpainThiohydantoinsresearch article33625671open accessAndrostenosAntagonistas de andrógenosAntineoplásicosNeoplasias de la próstataNeoplasias de la próstata resistentes a la castraciónOncología médicaOrquiectomíaPruebas genéticasRadioterapia10.1007/s12094-021-02561-51699-3055PMC8057980https://link.springer.com/content/pdf/10.1007/s12094-021-02561-5.pdfhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC8057980/pdf