{
  "abstract": "Background/Objectives: Androgen receptor pathway inhibitor (ARPI) intensification in metastatic hormone-sensitive prostate cancer has changed the population reaching metastatic castration-resistant prostate cancer (mCRPC), and the optimal sequence of subsequent therapies is uncertain. Methods: The study presents a narrative review of phase II/III trials reporting radiographic progression-free survival (rPFS) or overall survival (OS) in mCRPC, including congress data, to June 2026, graded on a five-level evidence hierarchy. Results: No prospective sequencing trial has been reported. CARD (cabazitaxel versus an ARPI switch after docetaxel; OS HR 0.64) remains the clearest sequencing dataset. Alpha-controlled OS benefit for PARP inhibitors is established in the PROfound cohort A (HR 0.69) and in the TALAPRO-2 all-comer population (HR 0.80); larger BRCA-specific estimates are exploratory, and BRCA OS in TRITON3 was not improved (HR 0.91). ¹⁷⁷Lu-PSMA-617 improved rPFS versus an ARPI switch in PSMAfore, but intention-to-treat OS did not differ (HR 0.91) amid 60% crossover; no taxane-controlled trial has shown an OS advantage, and in preliminary PLUDO data, OS favoured docetaxel first (HR 1.64), a difference potentially confounded by asymmetric crossover. Conclusions: We propose a hypothesis-generating four-track framework stratified by homologous recombination repair status and PSMA-PET expression; treatment choice remains individualised.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Internal Medicine, King Hussein Cancer Center (KHCC), Amman 11941, Jordan.",
    "Department of Nuclear Medicine, King Hussein Cancer Center (KHCC), Amman 11941, Jordan.",
    "Faculty of Medicine, Yarmouk University, Irbid 21163, Jordan."
  ],
  "article_type": "review article",
  "arxiv": null,
  "author_total": 9,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Baha Sharaf",
      "orcid": "0000-0003-4368-1224"
    },
    {
      "affs": [
        0
      ],
      "name": "Mohammad Al-Rwashdeh"
    },
    {
      "affs": [
        0
      ],
      "name": "Osama El Khatib",
      "orcid": "0000-0002-3697-7708"
    },
    {
      "affs": [
        1
      ],
      "name": "Akram Al-Ibraheem",
      "orcid": "0000-0002-0978-4716"
    },
    {
      "affs": [
        0
      ],
      "name": "Ala Abu Fara"
    },
    {
      "affs": [
        0
      ],
      "name": "Ameen Ismail"
    },
    {
      "affs": [
        0
      ],
      "name": "Hadeel Alkasrawi"
    },
    {
      "affs": [
        0
      ],
      "name": "Mohamed Abdalla",
      "orcid": "0009-0004-4451-4625"
    },
    {
      "affs": [
        2
      ],
      "name": "Sharif Jehad"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/0vk3dx6e994gc.bib",
  "cited_by": 0,
  "doi": "10.3390/cancers18193119",
  "fulltext_url": "https://europepmc.org/articles/PMC13664462",
  "id": "0vk3dx6e994gc",
  "issns": [
    "2072-6694"
  ],
  "landing_url": "https://europepmc.org/article/MED/42882814",
  "language": "eng",
  "licence": "CC-BY",
  "licence_label": "CC BY",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "openalex",
      "2740|Prostate Cancer Treatment and Research"
    ]
  ],
  "openalex": "W7214384176",
  "pdf_url": "https://europepmc.org/articles/PMC13664462?pdf=render",
  "pmcid": "PMC13664462",
  "pmid": "42882814",
  "published": "2026-09-25",
  "publisher": null,
  "ris": "https://research.draconitic.com/paper/0vk3dx6e994gc.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:19:16Z",
      "native_id": "MED:42882814",
      "source": "europepmc",
      "url": "https://europepmc.org/article/MED/42882814"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "issn:2072-6694",
      "subfield": "oncology"
    }
  ],
  "title": "Treatment Sequencing in ARPI-Pre-Exposed Metastatic Castration-Resistant Prostate Cancer: Radioligand Therapy, PARP Inhibitors, and Antibody-Drug Conjugates.",
  "title_text": "Treatment Sequencing in ARPI-Pre-Exposed Metastatic Castration-Resistant Prostate Cancer: Radioligand Therapy, PARP Inhibitors, and Antibody-Drug Conjugates.",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T12:19:16Z",
  "url": "https://research.draconitic.com/paper/0vk3dx6e994gc",
  "venue": "Cancers",
  "versions": []
}