Recent advances in drug treatment for prostate cancer.

With the advent of androgen receptor signaling inhibitors (ARSI), chemotherapy, poly (adenosine diphosphate-ribose) polymerase inhibitor (PARPi), and radioligand therapy targeting prostate-specific membrane antigen (PSMA), survival outcomes in metastatic prostate cancer (PCa) have dramatically improved over the past two decades. In addition, recent advancements in imaging modalities and genomic testing have significantly impacted diagnostic and therapeutic strategies for advanced PCa. However, with increasing drug options and the emergence of new disease concepts for non-metastatic castration-resistant prostate cancer (nmCRPC), treatment strategies for advanced PCa have become more complicated and uncertain. In addition, the emergence of aggressive PCa variants, including treatment-related neuroendocrine PCa (t-NEPC), is another clinical concern in the era of upfront and long-term use of potent ARSIs. The aim of this review is to summarize the latest drug treatment strategies and clinical concerns in the management of advanced PCa in Japan, based on the Japanese Clinical Practice Guidelines for Prostate Cancer published in 2023.