Castration-sensitive Prostate Cancer Market Projected to Grow at a 13.2% CAGR (2020-2034), Driven by Expanded Approval and Wider Commercialization Opportunity in nmCSPC Segment | DelveInsight

The CSPC market is poised for strong, double-digit growth, driven by aging demographics, improved screening, and strategic treatment advancements. While cost and access challenges persist, emerging therapies such as TRUQAP (AstraZeneca), TAVT-45 (Tavanta Therapeutics), Saruparib (AstraZeneca), AKEEGA (Johnson & Johnson Innovative Medicine [Janssen Pharmaceuticals]), TALZENNA (Pfizer), and others, along with global expansion, present promising CSPC market potential.

LAS VEGAS, Jan. 5, 2026 /PRNewswire/ -- DelveInsight's Castration-sensitive Prostate Cancer Market Insights report includes a comprehensive understanding of current treatment practices, CSPC emerging drugs, market share of individual therapies, and current and forecasted market size from 2020 to 2034, segmented into leading markets [the United States, the EU4 (Germany, France, Italy, and Spain), the United Kingdom, and Japan]. 

Castration-sensitive Prostate Cancer Market Summary

• According to DelveInsight's analysis, the market size for castration-sensitive prostate cancer was found to be USD 4.3 billion in the leading markets [the United States, the EU4 (Germany, France, Italy, and Spain), the United Kingdom, and Japan] in 2024.
• The United States accounted for the largest CSPC treatment market size, approximately 66% of the total market size in the 7MM in 2024, compared to other major markets, including the EU4 countries (Germany, France, Italy, and Spain), the United Kingdom, and Japan.
• Widespread Prostate-Specific Antigen (PSA) screening, earlier detection, aging populations, and improved cancer registry coverage are all fueling the rise in prostate cancer cases across the 7MM.
• Currently, second-generation ADTs (in the 7MM) dominate the prostate cancer market. According to market projections, by 2034, second-generation ADTs will hold the top spot.
• Novartis is advancing PLUVICTO as the first PSMA-targeted radioligand for the treatment of treatment-naïve or minimally treated mHSPC. Post-launch, PLUVICTO generated ~USD 980 million in 2023 for mCRPC, rapidly reaching billion-dollar status. With no approved radioligand therapies in CSPC and promising early results, similar growth is anticipated as it enters this untapped market. Leading CSPC companies developing emerging therapies, such as AstraZeneca, Tavanta Therapeutics, Madison Vaccines, Johnson & Johnson Innovative Medicine (Janssen Pharmaceuticals), Pfizer, Novartis, and others, are developing new CSPC treatment drugs that can be available in the CSPC market in the coming years. 
• The promising CSPC therapies in clinical trials include TRUQAP (capivasertib/AZD5363), TAVT-45 (abiraterone acetate), Saruparib (AZD5305), AKEEGA (niraparib and abiraterone acetate), TALZENNA (talazoparib), PLUVICTO (177Lu-PSMA-617), and others.

Discover the new CSPC treatment @ Castration-sensitive Prostate Cancer Treatment Market

Key Factors Driving the Growth of the Castration-sensitive Prostate Cancer Market 

Rising prostate cancer incidence and ageing populations

Prostate cancer incidence is strongly associated with age, most frequently diagnosed in men between 65 and 74 years. However, age-specific patterns vary across regions, with the lowest prevalence observed in individuals over 84 years in the US, while in Japan, cases are least common among men aged 54 years or younger. Overall, prostate cancer risk rises with advancing age, and ongoing global demographic shifts toward older populations are expanding the diagnosed patient pool, thereby increasing the addressable market for CSPC therapies and diagnostics.

Competitive Dynamics in the CSPC Market

XTANDI and ERLEADA lead the CSPC market with broad adoption and clinical validation, while newer entrants like NUBEQA and ORGOVYX are gaining ground, enhancing competition with differentiated benefits and expanding CSPC market share.

Advances in Mutation-Targeted CSPC Therapies

The development of therapies targeting specific mutations is expected to perform better in the future, such as AKEEGA (HRR gene-mutated mCSPC), TALZENNA (DDR-deficient mCSPC), TRUQAP (de novo PTEN-deficient mHSPC), and others.

Radioligand and PARP Inhibitors Driving Future CSPC Market Growth

The emergence of radioligand and PARP inhibitor therapies in CSPC makes it a lucrative market in the future. Johnson & Johnson, the first to demonstrate the benefits of the PARP + androgen receptor pathways combo (niraparib + abiraterone) in HRR-mutated mCSPC, may gain an early-mover advantage in precision CSPC.

Castration-sensitive Prostate Cancer Market Analysis

The current and emerging treatment paradigm of the CSPC market offers a broad spectrum of therapeutic options for prostate cancer management, spanning androgen receptor inhibitors, CYP17 inhibitors, PARP inhibitors, AKT inhibitors, PSMA-targeted radioligand therapies, GnRH receptor antagonists, and several others across different lines of therapy.

Androgen receptor pathway inhibitors remain central to the treatment of CSPC. In the United States, four such agents are approved: the anti-androgens ERLEADA, XTANDI, and NUBEQA, as well as ZYTIGA. NUBEQA has demonstrated steady momentum, showing nearly doubled quarter-on-quarter growth and achieving record-high revenues in recent periods, underscoring its expanding global adoption. ERLEADA appears to offer the most significant real-world benefit in terms of survival and PSA response, followed by XTANDI and then ZYTIGA. 

XTANDI has achieved robust global sales in recent years due to its established efficacy across multiple stages of prostate cancer, including mHSPC, and its growing role in combination regimens. Astellas reported a 21.6% year-over-year revenue increase from 2023 to 2024, supported by growth in all regions. However, the company anticipates a 4.9% sales decline in the near future, owing to expected patent expirations in Europe and Japan by 2026 and in the United States by 2027.

Androgen biosynthesis inhibitors such as ZYTIGA function by reducing androgen availability, thereby slowing tumor growth. Meanwhile, GnRH receptor antagonists like ORGOYVX offer a newer mode of androgen deprivation by directly and rapidly lowering LH and testosterone, avoiding the initial flare associated with LHRH agonists.

Beyond hormonal agents, PARP inhibitors, including saruparib and TALZENNA, represent a significant advance, particularly for patients harboring homologous recombination repair (HRR) mutations such as BRCA. Another innovative therapy is PSMA-targeted radioligand treatment, which delivers radiation specifically to PSMA-expressing tumor cells using compounds like [^177Lu] Lu-PSMA-617. Although currently approved for mCRPC, ongoing studies are exploring its use in earlier disease stages, including mCSPC.

Collectively, these treatment classes underscore the transition toward mechanism-based and biomarker-driven approaches in CSPC. By integrating hormonal suppression with targeted and precision medicine strategies, they aim to enhance patient outcomes across both non-metastatic and metastatic disease settings.

Castration-sensitive Prostate Cancer Competitive Landscape

Some of the CSPC drugs in clinical trials include TRUQAP (AstraZeneca), TAVT-45 (Tavanta Therapeutics), Saruparib (AstraZeneca), AKEEGA (Johnson & Johnson Innovative Medicine [Janssen Pharmaceuticals]), TALZENNA (Pfizer), and others.

Capivasertib is an orally administered pyrrolopyrimidine derivative that inhibits the serine/threonine-protein kinase AKT (protein kinase B) and shows potential antitumor activity. AstraZeneca has completed Phase Ib and Phase I/II trials of capivasertib for prostate cancer. The company is currently evaluating capivasertib in combination with ZYTIGA in the Phase III CAPItello-281 study for mHSPC, and in combination with docetaxel in the CAPItello-280 study for mCRPC.

In November 2024, the CAPItello-281 Phase III trial reported positive top-line results: AstraZeneca's TRUQAP, combined with abiraterone and ADT, significantly improved the primary endpoint of rPFS compared to abiraterone and ADT with placebo in patients with PTEN-deficient de novo mHSPC.

TAVT-45 is a new oral suspension formulation of abiraterone acetate, developed as a patient-friendly alternative to ZYTIGA tablets. Its pivotal Phase III trial confirmed therapeutic equivalence to ZYTIGA in patients with mCRPC and high-risk mCSPC, with a comparable safety profile. The NDA is currently in preparation. Tavanta is exploring strategic partnerships for late-stage development and commercialization, targeting patients who have difficulty swallowing traditional tablets.

Saruparib (AZD5305) is a selective oral PARP inhibitor that specifically targets and traps PARP1, unlike existing PARPis that inhibit both PARP1 and PARP2. Preclinical studies suggest that PARP1 inhibition provides antiproliferative effects, while PARP2 inhibition contributes to hematological toxicity, indicating AZD5305 may offer a better therapeutic index with reduced toxicity. It is currently in Phase III development for both HRRm and non-HRRm mCSPC.

According to AstraZeneca's Q1 2025 clinical trial update, data from saruparib Phase III (EvoPAR-Prostate01/NCT06120491) and Phase I/IIa (PETRANHA/NCT05367440) trials are expected beyond 2026.

The anticipated launch of these emerging therapies is poised to transform the CSPC market landscape in the coming years. As these cutting-edge therapies continue to mature and gain regulatory approval, they are expected to reshape the CSPC market landscape, offering new standards of care and unlocking opportunities for medical innovation and economic growth.

Discover more about the CSPC drugs market @ Castration-sensitive Prostate Cancer Drugs 

Recent Developments in the Castration-sensitive Prostate Cancer Market

• In June 2025, Bayer announced that the FDA had approved its oral Androgen Receptor Inhibitor (ARI) NUBEQA in combination with ADT for use in patients with mCSPC. The approval is based on positive results from the pivotal Phase III ARANOTE trial in patients with metastatic hormone-sensitive prostate cancer (mHSPC).
• In June 2025, Novartis announced topline results from a pre-specified interim analysis of the Phase III PSMAddition trial. 
• In June 2025, Johnson & Johnson Innovative Medicine presented late-breaking data from the Phase III AMPLITUDE (Oral Abstract: LBA5006) trial, evaluating AKEEGA plus prednisone in patients with mCSPC and alterations in homologous recombination repair genes, at the American Society of Clinical Oncology (ASCO) meeting in Chicago, 2025.
• In May 2025, Astellas Pharma and Pfizer announced longer-term follow-up results from an open-label extension of the Phase III ARCHES study in men with mHSPC treated with XTANDI plus ADT compared to placebo plus ADT. These data were presented during an oral presentation (Abstract #5005) at the ASCO Annual Meeting in Chicago.
• In April 2025, in a real-world, head-to-head study, data from TITAN evaluating ERLEADA versus XTANDI in patients with mCSPC were presented at the 50th Annual Oncology Nursing Society (ONS) Congress.

Castration-sensitive Prostate Cancer Overview

Prostate cancer is a prevalent malignancy that arises in the prostate gland, primarily affecting men. It generally progresses slowly and often remains localized to the prostate during its early stages, typically causing minimal harm. In more advanced stages, the disease can progress to mCSPC, also known as mHSPC. This stage involves cancer that has spread beyond the prostate to other areas of the body but still responds to hormone (androgen deprivation) therapy. Metastatic prostate cancer is further categorized based on imaging results:

• M0 CSPC: No detectable metastases on standard imaging.
• M1 CSPC: Metastases are confirmed to be present.

Distinguishing M0 CSPC from a local recurrence after curative treatment can be difficult, with histological analysis and PSA (prostate-specific antigen) levels being crucial for accurate diagnosis. Meanwhile, nmCSPC refers to prostate cancer that is limited to the pelvic region with no signs of distant metastasis on imaging, yet remains responsive to hormone-lowering therapy.

Castration-sensitive Prostate Cancer Epidemiology Segmentation

The CSPC epidemiology section provides insights into the historical and current CSPC patient pool and forecasted trends for the leading markets [the United States, the EU4 (Germany, France, Italy, and Spain) and the United Kingdom, and Japan]. It helps recognize the causes of current and forecasted patient trends by exploring numerous studies and views of key opinion leaders.

The CSPC treatment market report proffers epidemiological analysis for the study period 2020–2034 in the leading markets [the United States, the EU4 (Germany, France, Italy, and Spain) and the United Kingdom, and Japan], segmented into:

• Total Prevalent Cases of Prostate Cancer
• Five-year Prevalent Cases of Prostate Cancer
• Age-specific Cases of Prostate Cancer
• Total Cases of Prostate Cancer by Clinical Stages
• Five-year Prevalent Cases of CSPC
• Total Prevalent Cases of nmCSPC and mCSPC 

Scope of the Castration-sensitive Prostate Cancer Market Report

• Therapeutic Assessment: Castration-sensitive Prostate Cancer, current marketed and emerging therapies
• Castration-sensitive Prostate Cancer Market Dynamics: Key Market Forecast Assumptions of Emerging Castration-sensitive Prostate Cancer Drugs and Market Outlook
• Competitive Intelligence Analysis: SWOT and Conjoint analysis and Market entry strategies
• Unmet Needs, KOL's views, Analyst's views, Castration-sensitive Prostate Cancer Market Access and Reimbursement

Download the report to understand the CSPC market trends @ Castration-sensitive Prostate Cancer Market Forecast 

Table of Contents

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