Here's some "light" reading... " https://www.urotoday.com/library-resources/mhspc/147798-the-current-state-of-treatment-implementation-for-mhspc-in-north-america.html?utm_source=newsletter_12452&utm_medium=email&utm_campaign=the-underutilization-of-treatments-and-testing-in-advanced-prostate-cancer

For those who don't want to wade through he charts and data...

Conclusions:

Although there appears to be increasing utilization of treatment intensification in the real-world setting, less than half of mHSPC patients receive guideline concordant care. While there may be altruistic reasons to avoid treatment intensification secondary to concerns for patient financial toxicity or concerns for the tolerability of these agents, the proven survival benefit conferred by this treatment paradigm should make this approach the clear standard of care. Based on the current evidence, it appears that patients with synchronous, high volume mHSPC benefit from early treatment intensification with triplet therapy in the form of both an ARPI and docetaxel, whereas the remaining mHSPC subgroups benefit most from doublet therapy with ARPI addition to ADT. Radiotherapy to the prostate is also associated with improved overall survival in mHSPC patients with synchronous, low-volume disease and should be considered in these cases.