Editor’s Note: In 2026, the Advanced Prostate Cancer Consensus Conference (APCCC), one of the most influential international expert consensus meetings in advanced prostate cancer, brought together experts from around the world to discuss systemic treatment strategies, risk-adapted treatment decisions, and emerging combination therapies, providing important guidance for clinical practice worldwide.In this issue of UroStream, we are pleased to feature Joe M. O’Sullivan, an APCCC expert from Queen’s University Belfast, UK, for an in-depth discussion of the latest updates from APCCC 2026 and future directions in combination therapy. He shares his perspectives on treatment sequencing, emerging therapeutic strategies, and improving access to advanced prostate cancer care.
UroStream: What are the most important updates and areas of controversy in the APCCC 2026 consensus regarding sequencing and combination strategies for hormonal therapy in advanced prostate cancer?
Joe M. O’Sullivan: This is a very good question. Regarding the key controversies in prostate cancer treatment discussed at APCCC 2026, there is now a fairly clear consensus that patients with metastatic castration-sensitive prostate cancer (mCSPC) should receive ADT combined with a novel endocrine therapy, such as an androgen receptor pathway inhibitor (ARPI). There is broad agreement on this point.
However, controversy remains regarding which patients may derive additional benefit from adding docetaxel. In other words, whether chemotherapy should be added to ADT plus an ARPI still depends on patient risk stratification and individualized treatment decisions. Notably, at this year’s APCCC, there was consensus on adding a PARP inhibitor for patients with BRCA mutations, whereas consensus has not yet been reached for other types of homologous recombination repair (HRR) alterations. This represents an important change compared with previous consensus recommendations.
UroStream: In metastatic prostate cancer, how do you view the future integration of systemic therapy with radioligand therapy, as well as the combination of novel hormonal therapy with radiotherapy?
Joe M. O’Sullivan: I think this is a very exciting area with considerable potential. We already know that androgen pathway inhibition can enhance radiosensitivity, suggesting that hormonal therapy and radiation-based therapies may have synergistic effects. For example, in the PEACE-3 study, the combination of enzalutamide and ADT with radium-223 demonstrated an overall survival benefit, suggesting potential synergy between these treatment modalities.
In addition, several studies are currently investigating combinations such as ARPI plus ADT with ^177Lu-PSMA. As more radioligand therapies are developed, combining them with ARPIs is likely to become an important research direction. PARP inhibitors may also enhance radiosensitivity, making their combination with radioligand therapy another area of potential interest. Overall, I believe this is a highly promising field for future research.
UroStream: Significant differences remain in prostate cancer care pathways across countries and regions. What do you consider the key priorities for advancing prostate cancer care globally?
Joe M. O’Sullivan: I agree. There are substantial differences not only between countries but even within individual countries.
In the clinical environment in the UK, for example, we see an important issue whereby patients from lower socioeconomic backgrounds are more likely to be diagnosed at an advanced stage and are also less likely to receive potentially curative treatment. In this sense, prostate cancer reflects broader inequalities within society.
From a healthcare perspective, I believe one important priority is improving access to advanced imaging technologies such as PSMA PET. PSMA PET currently represents the cutting edge of prostate cancer imaging. If more patients could access this technology, it could improve diagnostic accuracy and further optimize treatment decision-making. Over the next 5–10 years, I hope that access to these advanced technologies can gradually be expanded worldwide, ultimately improving outcomes for patients with prostate cancer.
Joe M. O’Sullivan Professor
