September is Prostate Cancer Awareness Month. It is the most common cancer among men in the US, with nearly 15 percent of men diagnosed with localized prostate cancer developing metastatic (widespread and incurable) cancer during their lifetime.

Treatment options are improving; two new studies presented at the American Society of Clinical Oncology (ASCO) annual meeting in Chicago offer hope to patients newly diagnosed with metastatic prostate cancer. Arpit Rao, MD, University of Minnesota Physicians oncologist hematologist and renowned prostate cancer expert, gave insight into these exciting new developments.

One such development is ENZAMET, a phase 3 clinical trial. ENZAMET compares enzalutamide in combination with androgen deprivation therapy (ADT) to a control group using older-generation antiandrogen with ADT for those newly diagnosed with metastatic prostate cancer. Of the 1,125 men treated across three continents, enzalutamide decreased disease progression risk by 71% when compared to the control group. Enzalutamide was very well tolerated, and side effects when they did occur, were manageable. The ENZAMET trial results lay the foundation for a possible FDA-approval, to be used in newly diagnosed metastatic prostate cancer cases and thus changing the treatment landscape.

TITAN, a second phase 3 clinical trial, evaluated the effectiveness of apalutamide, a drug similar to enzalutamide that directly blocks the testosterone receptor inside of cancer cells. In TITAN, of 1052 men with metastatic hormone-sensitive prostate cancer, apalutamide decreased the risk of cancer progression by 52% and the risk of death by 33% compared with the control group. The treatment was very well tolerated and side effects were manageable. Currently, apalutamide is not FDA-approved for metastatic prostate cancer, but the TITAN trial results make it likely that it will become an option for patients in the future.

“A few extra pills a day could help our patients with metastatic prostate cancer go longer before needing the next treatment and live longer. These treatments also have very manageable side effects and most men continue to feel about the same, if not better, with treatment as they did when they were first diagnosed."

“These patients are often in their 70’s, so getting them to their 80th birthday is a huge milestone, and it has become more possible because of these drugs.”

Arpit Rao, MD, University of Minnesota Physicians oncologist hematologist

Enzalutamide and apalutamide give doctors and patients more choices for this crucial decision. Most new treatments block the function of testosterone in cancer cells, but eventually, the cancer cells escape this restriction and the treatments cease to work.