Androgen deprivation therapy (ADT) can slow the growth of aggressive prostate cancer and prolong survival in men with metastatic castration-sensitive disease (prostate cancer that has spread but responds to ADT). Two studies published in 2019 in The New England Journal of Medicine show that adding a second-generation androgen-receptor blocking drug can further improve survival in such men.
Researchers randomly assigned 525 men with metastatic castration-sensitive prostate cancer to treatment with ADT plus apalutamide (Erleada) and 527 to treatment with ADT plus placebo. Overall survival after a median follow-up of two years was 82 percent for the ADT plus apalutamide group compared with 73.5 percent for those treated only with ADT.
In a separate study, researchers randomly assigned 563 men with metastatic castration–sensitive prostate cancer to treatment with ADT plus enzalutamide (Xtandi) and 562 to treatment with ADT plus placebo. Of the men in the ADT plus enzalutamide group, 80 percent survived a median of three years, compared with 72 percent of those who received ADT alone.
Previous research indicates that combining the second-generation androgen blocker abiratarone (Zytiga) or the chemotherapy drug docetaxel with ADT also improves survival. Questions remain about which men might be the best candidates for a given treatment, and the cost of the newer drugs is a major concern.