Evolution in the management of nmCRPC

With the relatively recent approvals of apalutamide (Erleada) and enzalutamide (Xtandi) for the treatment of non-metastatic, castration-resistant prostate cancer (nmCRPC), we are seeing intense discussion within the urologic oncology and medical oncology communities about the appropriate treatment of patients with this category of prostate cancer.

A new review article by Mateo et al. — the full text of which is currently available on line — provides a thorough overview of this topic. It is an article that many support group leaders and other prostate cancer educators may want to download for their files.

A key point made by the authors of this paper is that “nmCRPC is a heterogeneous disease”, and consequently that

… while observation may be an option for some patients, enzalutamide and apalutamide may be appropriate to treat nmCRPC patients with PSA [doubling times] ≤ 10 months.

We would draw the reader’s attention to the importance of the term “may be” in this sentence.

The authors also note another point that we have also addressed previously:

The emergence of more accurate imaging modalities as well as circulating tumour biomarker assays will likely redefine the assessment of nmCRPC in the near future.

3 Responses

  1. No doubt that “non-metastatic” will be found to have been an inaccurate conclusion in many cases with these new scans. Where does that put these two drugs? Are they useful for mCRPC?


  2. Dear Bob:

    Enzalutamide (Xtandi) was approved some time ago for the treatment of chemotherapy-naive men with mCPRC and, as its very first indication, for the treatment of men with mCRPC after treatment with docetaxel chemotherapy.

    Apalutamide (Erleada) is currently approved exclusively for the treatment of men with chemotherapy-naive nmCRPC, but it is currently in some 40+ clinical trials for treatment of both earlier and later stages of prostate cancer, so I am sure there will be more indications to come.

  3. Just leaving this here. It has now been 9.5 years since I left Amsterdam for treatment in Uppsala. Yesterday I had one of my last PSA examinations. The density is undetectable and has been so since neoadjuvant ADT. I’m in a pretty good mood. Two days ago I was online with some smart radiologists I met on Twitter last year. They were discussing shared decision making. They were glad I decided as I did.

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