Thanks for posting this important study, even if the conclusion is quite sobering.

I noted, at the end of your 2nd link, that an important “ TRIPLE-SWITCH” RCT has been initiated to answer the last concern mentioned in your post.

The TRIPLE-SWITCH trial is a randomized phase III clinical trial designed to address a specific gap in the management of metastatic castration-sensitive prostate cancer (mCSPC).

The trial focuses on patients with mCSPC who have a suboptimal PSA response (PSA ≥ 0.2 ng/mL) after initial treatment with androgen deprivation therapy (ADT) plus an androgen receptor pathway inhibitor (ARPI), such as abiraterone, enzalutamide, or apalutamide.

The TRIPLE-SWITCH trial aims to answer this Key Question:

Does adding docetaxel (chemotherapy) to the existing doublet therapy (ADT + ARPI) improves outcomes for mCSPC patients with suboptimal PSA response, compared to continuing the doublet therapy alone?

Specifically, it investigates whether this triplet therapy (ADT + ARPI + docetaxel) delays progression to castration-resistant prostate cancer (CRPC) and improves survival in this subgroup, which is at higher risk of early disease progression.

Hopefully, an improved therapy will be proven for those in the worst affected (>0.20 PSA) mCSPC group.
https://clinicaltrials.gov/study/NCT06592924