Prostate cancer treatment changes to reduce risk of metastasis

Early diagnosis of prostate cancer allows for definitive surgical intervention. This operation is sufficient for a cure in most cases, but unfortunately, in 20-40% of cases, it does not prevent the development of what is called biochemical recurrence (BCR). This condition leads to metastatic disease in 90% of cases. This process can be detected by measuring PSA, which rapidly rises, indicating an increased risk of the tumor returning. To try to slow the onset of advanced disease, a new option is now available in Italy: enzalutamide, a molecule already widely used in all phases of treatment for advanced and metastatic prostate cancer, whether sensitive or resistant to castration.

A new indication

The new development is that the use of enzalutamide has been extended to include non-metastatic hormone-sensitive patients whose treatment with surgery or radiotherapy has not been sufficient and who experience a high-risk biochemical recurrence, indicated by a rapidly rising PSA level, an early sign of a return of disease with a high risk of metastasis. "Enzalutamide has proven effective precisely in this setting of patients who were otherwise treated with hormone therapy alone. Enzalutamide, as monotherapy or in combination with androgen deprivation therapy, changes the therapeutic paradigm for those patients who have a high probability of progression after initial treatment and opens the way to a new therapeutic perspective with solid evidence that offers effective treatment for patients with recurrence after surgery who are not amenable to postoperative radiotherapy, for those who have progressed after postoperative radiotherapy, and for those with recurrence after radiotherapy alone," explains Stefano Arcangeli , Associate Professor of Radiotherapy, University of Milan Bicocca and Director of the Radiotherapy Department, Fondazione IRCCS San Gerardo dei Tintori, Monza.

The effectiveness results

Enzalutamide is a next-generation anti-androgen drug that acts on prostate cancer tumor cells by blocking androgen receptors. "In the Embark study, enzalutamide, as monotherapy or in combination with androgen deprivation therapy, was shown to prolong metastasis-free survival in patients with resected or radiotreated prostate cancer who had rapidly rising PSA levels," says Ugo De Giorgi , Associate Professor of Medical Oncology at Unisalento and Director of the Oncology Department at Fazzi Hospital, Lecce. "The drug slows tumor progression, reducing the risk of metastases and prolonging the time until PSA levels progress. Furthermore, enzalutamide use is associated with stable or improved health-related quality of life."