Systemic Treatments in Men with De Novo Metastatic Prostate Cancer.

De novo metastatic prostate cancer represents a biologically and clinically distinct subset of metastatic hormone-sensitive prostate cancer characterized by aggressive disease behavior and poor survival outcomes. Although androgen deprivation therapy (ADT) has long been the cornerstone of systemic management, recent advances transformed the treatment paradigm toward intensified combination regimens. The addition of docetaxel or androgen-receptor-pathway inhibitors such as abiraterone, enzalutamide, apalutamide, or darolutamide to ADT has demonstrated significant improvements in survival. More recently, triplet strategies combining ADT, docetaxel, and either abiraterone or darolutamide have produced further survival gains without excess toxicity. Molecular insights have advanced precision-based approaches.