Although there have been significant advancements in the systemic treatment of advanced prostate cancer, metastatic prostate cancer remains an incurable disease. The overall survival rate at 5 years for patients initially diagnosed with metastatic hormone-sensitive prostate cancer (mHSPC) is 30%. The prognosis is typically better for people with low-volume disease and for those with metachronous metastatic disease compared to de novo synchronous metastatic disease. Despite an initial high response rate, many patients ultimately develop metastatic castration-resistant prostate cancer (mCRPC). Factors such as disease extent, visceral involvement, timing of metastasis, genetic alterations, and histological differentiation influence the risk of progression. Integrating treatments with diverse mechanisms often provides the best chance for tumor regression. Recent clinical trials have demonstrated significant improvements in overall survival, particularly in synchronous, high-volume disease, transforming mHSPC into a disease with the goal of durable control. The evolving landscape of mHSPC demands individualized, evidence-based approaches, integrating systemic, local, and targeted therapies to optimize disease control and patient quality of life.