Treatment of patients with histologically confirmed prostate cancer after radical prostatectomy

In this phase III trial, researchers compared treatments for patients with recurring prostate cancer. They looked at using hormone therapy alone, hormone therapy with apalutamide, or hormone therapy with abiraterone/prednisone and apalutamide. Patients had previously had surgery and had a rising level of prostate-specific antigen (PSA).

They found that more patients completed the 52-week treatment with the combination therapies. After about 21.5 months, they observed that both combination treatments improved the time before PSA levels rose again compared to hormone therapy alone. There was no significant difference between the two combination therapies.

The time it took for testosterone levels to return to normal after treatment was similar across all three groups. However, there were more interruptions in treatment and more side effects like rashes and hypertension in the groups receiving the combination therapies.

Based on these findings, the combination therapies didn’t significantly change outcomes compared to hormone therapy alone. Future trials should consider using PET scanning for better patient selection. Treatments like stereotactic body radiotherapy (SBRT) or surgery might be preferred for some patients.

Overall, the time of using only hormonal treatments for recurring prostate cancer might be over, with more emphasis on personalized treatments and combinations of therapies emerging.

Practice Update. February 14, 2024.