Advancements in aggressive prostate cancer therapy

Enzalutamide improves recurrent prostate cancer prognosis.


Aggressive prostate cancer poses a significant medical challenge, and researchers have been exploring innovative approaches to improve treatment outcomes. This study examines the latest advancements and promising options for managing aggressive prostate cancer.

At Cedars-Sinai Cancer Center, researchers found two new treatments for men with recurring prostate cancer. These treatments are better than the current ones, helping patients live longer without their cancer worsening. Their findings were published in the New England Journal of Medicine.

Stephen Freedland, MD, associate director for Training and Education and the Warschaw, Robertson, Law Families Chair in Prostate Cancer at Cedars-Sinai, and lead author of the study said, “If the Food and Drug Administration approves these treatments, our results will be practice-changing. In the study, both new options improved metastasis-free survival while preserving quality of life.”

In 2023, an estimated 288,300 men in the U.S. will be diagnosed with prostate cancer, a gland important for semen production. Some have a slow-growing type and may not need treatment, but those with aggressive forms often get surgery or radiation.

Unfortunately, cancer returns within a decade for about a third of these patients. They’re then treated with hormone therapy (ADT) that lowers testosterone, a hormone that helps cancer grow. But ADT has drawbacks: It doesn’t eliminate all testosterone and can lead to side effects.

When you’re on hormone therapy (ADT), your testosterone level drops but doesn’t disappear completely. There’s concern that the remaining testosterone might still fuel tumor growth, and patients don’t like being on hormones.

In a study with 1,068 prostate cancer patients from 244 sites in 17 countries, researchers tested two experimental treatments to deal with these problems.

In a randomized clinical trial, one-third of the patients got ADT and a drug called enzalutamide. This drug blocks testosterone’s effects, preventing any remaining testosterone from fueling cancer cell growth.

In the study, another third of the patients got only enzalutamide. This relied on the drug to block testosterone’s effects, even if testosterone levels in their blood didn’t drop.

The last group of patients got the current standard treatment, ADT alone.

The results showed that combining ADT with enzalutamide reduced the risk of cancer spreading or death by 58% compared to ADT alone. Enzalutamide alone decreased the risk by 37% compared to ADT alone. Both treatments maintained the patients’ quality of life compared to just ADT.

Freedland said that “while the combination therapy offers more significant risk reduction, some men might prefer enzalutamide alone. It does an excellent job of preventing cancer spread or death, with different side effects that may be more acceptable for some men. The next step is for the makers of enzalutamide to apply for FDA approval so the experimental therapy can be widely used.”

Dan Theodorescu, MD, PhD, director of Cedars-Sinai Cancer and the PHASE ONE Distinguished Chair, said, “Optimizing therapy for patients with aggressive recurrence after their prostate cancer is initially treated has been an unmet need. The results of this trial point the way to two options the study showed were more effective than the current standard of care, allowing these patients and their providers to choose a potentially improved course of therapy that best meets their needs.”

Aggressive prostate cancer remains a pressing healthcare challenge, but promising options are emerging. Researchers are making significant strides in improving the management of this aggressive form of cancer, from targeted therapies to immunotherapy, precision medicine, and combination therapies. 

Detecting the disease earlier also plays a pivotal role in achieving better outcomes. Further research, clinical trials, and integrating these promising treatments into standard practice are essential for addressing this critical health issue and providing hope for those diagnosed with aggressive prostate cancer.

Journal reference:

  1. Stephen J. Freedland, M.D., Murilo de Almeida Luz, M.D. et al., Improved Outcomes with Enzalutamide in Biochemically Recurrent Prostate Cancer. New England Journal of Medicine. DOI: 10.1056/NEJMoa2303974.
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