Evan Y. Yu, MD, discusses how individualized first-line systemic therapy selection for metastatic hormone-sensitive prostate cancer (mHSPC) involves considering factors such as disease burden, patient performance status, and comorbidities while weighing the pros and cons of current options—such as chemotherapy-sparing regimens, androgen receptor pathway inhibitor (ARPI) selection, and the use of triplet versus doublet combination therapies—to optimize efficacy and minimize adverse effects based on each patient’s unique clinical profile.