Introduction
Metastatic hormone-sensitive prostate cancer (mHSPC) represents a critical stage in prostate cancer requiring intensified systemic therapy. The advent and expanded approval of androgen receptor axis-targeted (ARAT) agents—such as darolutamide, abiraterone, apalutamide, and enzalutamide—have meaningfully advanced treatment options beyond traditional androgen deprivation therapy (ADT). Additionally, chemotherapy with docetaxel has been incorporated into regimens to improve outcomes. Yet, an important clinical question remains: Do older patients with mHSPC, often facing increased comorbidities and frailty, derive comparable benefit from these intensified doublet or triplet therapies as younger counterparts?
