Dr. Pinski: mHSPC treatment evolved from ADT to triplet therapy (ADT+RPI+docetaxel), improving survival; biomarkers guide personalized care. Dr. Slovin: PARP inhibitors improve PFS in mHSPC, especially with BRCA1/2; key trials positive, but risks like MDS highlight need for biomarkers. Dr. Iravani: lutetium PSMA improves PFS (OS in VISION); outcomes depend on PSMA expression; imaging + biomarkers key for patient selection. Dr. Choudhury: AKT inhibitors show PFS benefit in PTEN-loss prostate cancer, but no OS gain; efficacy tied to PTEN status, with notable toxicities. Dr. Petrylak: ARV-110/766 PROTACs target AR mutations in mCRPC; show PSA responses, with ARV-766 and lutetium combo promising in trials. Roundtable Discussion: prostate cancer remains complex; need better patient selection, biomarkers, and tailored therapy; PSMA imaging and de-escalation under study.