PC incidence is rising in Taiwan, with 30% of new cases presenting with metastatic disease. The treatment landscape of mPC is rapidly evolving, driven by findings from landmark phase III trials such as ARANOTE and PEACE-III. However, these advances have introduced complexity in clinical decision-making, particularly regarding optimal treatment selection and sequencing.

A multidisciplinary advisory board comprising 12 Taiwanese PC experts, including urologists, medical oncologists, and radiation oncologists, convened to review treatment intensification strategies for both mHSPC and mCRPC. Discussions were grounded in recent clinical trial data, international guidelines, and Taiwan’s healthcare context.

Combination therapies are increasingly recognized as more effective than sequential monotherapies in mPC management. Treatment selection must consider both patient- and treatment-specific factors. In light of recent clinical trial results and updated guidelines, the advisory board endorses doublet therapy (ARPI + ADT) for improving outcomes in mHSPC patients, and triplet therapy (ARPI + ADT + docetaxel) for high-risk patients suitable for chemotherapy. Although current reimbursement criteria in Taiwan limit both doublet and triplet therapy to high-risk patients, clinical evidence supports potential broader accessibility to doublet therapy. Darolutamide, as evaluated in the ARANOTE trial, offers enhanced therapeutic flexibility—providing an effective doublet option for both low- and high-volume mHSPC patients, including those unsuitable for chemotherapy, and a triplet option for eligible patients. Ongoing trials—including CAPItello-281, AMPLITUDE, TALAPRO-3, and PSMAddition—are evaluating novel combination strategies, including targeted therapies and radioligand treatments. The use of combination regimens is becoming an increasingly important trend in the evolving treatment landscape of mPC. However, despite these advancements, an estimated 30–50% of mHSPC patients in Taiwan still receive ADT monotherapy. Preliminary results from the ongoing PEACE-III trial suggest the potential benefits of combining enzalutamide and radium-223 as first-line therapy for mCRPC asymptomatic patients with bone metastases, indicating improvements in rPFS and OS. The evolving management paradigm at earlier stages of disease is likely to support the future integration and clinical application of findings from the PEACE-III trial. As treatment options continue to expand, there is increasing interest in exploring de-intensification strategies aimed at minimizing cumulative toxicities and enhancing long-term QoL for patients.

A patient-centered, multidisciplinary approach is vital to optimizing outcomes for mPC patients. Ongoing research, supplemented by real-world evidence, remains essential for refining personalized treatment strategies and bridging access gaps within Taiwan’s healthcare environment.