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Treatment Options for Nonmetastatic CRPC

Rashid K. Sayyid, MD, MSc, gives a brief overview of treatment options for nonmetastatic castrate-resistant prostate cancer.

This is a synopsis of an Educated Patient Sound Bites series featuring Alicia Morgans, MD, MPH, of Dana-Farber Cancer Institute; Rashid K. Sayyid, MD, MSc, of the University of Toronto; and Reginald Tucker-Seeley, MA, ScM, ScD, of ZERO Prostate Cancer.

Dr Rashid K. Sayyid defines nmCRPC [non-metastatic castration-resistant prostate cancer] as evidence of castration resistance without metastases on CT or bone scan. He notes recent progress in nmCRPC treatment, with FDA approval of second-generation antiandrogens apalutamide, enzalutamide, and darolutamide along with continued androgen deprivation therapy (ADT). Approvals were based on the phase 3 ARAMIS, PROSPER, and SPARTAN trials respectively.

The ARAMIS trial randomized patients with nmCRPC with rapidly rising prostate-specific antigen (PSA) to darolutamide or placebo plus ADT. Metastasis-free survival increased from 18 to 40 months with darolutamide, reducing death risk by 31%. Similarly, the PROSPER trial using enzalutamide improved metastasis-free and overall survival by 11 months. Finally, the SPARTAN trial with apalutamide extended metastasis-free survival by 2 years and overall survival over 1 year.

In summary, Dr Rashid K. Sayyid reviews recent progress in treating non-metastatic castrate-resistant prostate cancer with second-generation antiandrogens apalutamide, enzalutamide, and darolutamide. The phase 3 ARAMIS, PROSPER, and SPARTAN trials supported FDA approval.

*Video synopsis is AI-generated and reviewed by CURE editorial staff.

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Dr. Neeraj Agarwal is a medical oncologist, a professor of medicine and the Presidential Endowed Chair of Cancer Research at the Huntsman Cancer Institute, University of Utah, as well as director of the Genitourinary Oncology Program and the Center of Investigational Therapeutics at the Huntsman Cancer Institute in Salt Lake City.
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