The treatment of metastatic hormone-sensitive prostate cancer (mHSPC) has made significant progress in recent years. Androgen deprivation therapy (ADT) alone is gradually being phased out and replaced by doublet or triplet intensified therapies combining ADT with novel androgen receptor pathway inhibitors (ARPIs) and/or docetaxel. In addition, for patients with low-volume or oligometastatic disease, local radiotherapy or cytoreductive surgery of the primary prostate tumor has shown the potential to improve survival. With the continuous enrichment of treatment modalities, risk stratification based on tumor volume and timing of metastasis is crucial for making individualized treatment decisions. In the future, precision targeted therapies for DNA damage repair defects and the PI3K/AKT pathway, as well as radioligand therapies (such as Lu-PSMA), are expected to further improve the prognosis of mHSPC patients. This article reviews the latest drug therapies, local therapies, risk-stratified treatment strategies, and future perspectives for mHSPC, aiming to provide a reference for clinical practice.