Optimal PSA Triggered Individual Management of Androgen Sensitive Prostate Cancer

This study (called OPTIMA) is testing an individualized approach to managing hormone-sensitive prostate cancer that has spread to other parts of the body. Instead of continuous hormone therapy, it uses PSA blood test levels to guide when to start and stop treatment, aiming to maintain quality of life while keeping the cancer controlled. **You may be eligible if...** - You are 18 or older and have confirmed metastatic hormone-sensitive prostate cancer - Your PSA level is 1 ng/mL or higher at the start - You are functional (ECOG 0–2) - For Cohort A: You have not yet received hormone-blocking therapy for metastatic disease - For Cohort B: Your PSA has already dropped below 0.2 ng/mL from hormone therapy - You have a smartphone and can use study apps **You may NOT be eligible if...** - You have already received standard hormone therapy (leuprolide or surgical castration) for metastatic disease (Cohort A) - You have brain or spinal fluid metastases that are not adequately treated - You have another active cancer - You have a condition that would prevent you from safely participating Talk to your doctor to see if this trial is right for you.