Improved Outcomes with Enzalutamide in Biochemically Recurrent Prostate Cancer

SPS commentary:

According to an editorial, these data do support the benefits of early cancer control with systemic therapy outweighing its risks in a subgroup of men with biochemical recurrence. It notes that the results also confirm that in this population, as in men with more advanced stages, adding an androgen-receptor inhibitor increases the efficacy of androgen-deprivation therapy (ADT). It adds that as well as developing more effective drugs with fewer toxic effects, tilting the scale to maximize benefit will require better predictors of prostate cancer lethality and treatment effect. It points out the definition of benefit is arguably the greatest hurdle, and the need for lengthy follow-ups and the near impossibility of controlling for the influence of subsequent therapies in an evolving landscape make prostate cancer–specific survival an impractical end point. Furthermore, metastasis-free survival still requires prolonged follow-up and is confounded by the proportion of non–prostate cancer deaths in this population and by the emergence of increasingly sensitive imaging that detects metastases earlier. It suggests that eugonadal progression-free survival might make the case for early intermittent treatment because current standards include lifelong ADT in men with detectable metastases, and delaying their detection or progression may decrease the total on-treatment time during a life with prostate cancer, even if overall survival is unchanged.