When should ADT be started upon or after BCR in HSPC? An unanswered question.

[MateoBeach]

Below is the commentary by Dr. Antonarakis upon the release of the most recent OS results from the SPARTAN trial of apalutamide in nmCRPC. Great results indeed! But what of those who are not yet castrate resistant?

However, note the last sentence (highlighted). An important unanswered question indeed. Should it be guided by PSADT or what?

practiceupdate.com/c/106535...

Emmanuel S Antonarakis MD:

"This study represents the mature analysis of overall survival from the SPARTAN study, a randomized trial of apalutamide versus placebo for nonmetastatic CRPC. The current analysis shows that, in addition to improving metastasis-free survival, there are now compelling data for an overall survival improvement using apalutamide for CRPC patients before the onset of metastatic disease. Taken together with the results of the PROSPER trial (enzalutamide vs placebo) and the ARAMIS trial (darolutamide vs placebo), both of which also showed a survival advantage with the use of novel antiandrogen therapy in the nonmetastatic CRPC setting, there is now substantial evidence of significant clinical benefit when using all three agents before the onset of metastatic disease. However, the question that is not answered by any of these trials is whether androgen-deprivation therapy should be started in the first place for nonmetastatic biochemically recurrent prostate cancers or what triggers should be used to decide when to start androgen-deprivation therapy in biochemically recurrent patients."

[Tall_Allen]

TOAD attempted to answer that. I hope they will publish 10-year results.

[podsart in reply to Tall_Allen]

I was surprised in some study I thought said Xtandi did better than Apalutamide or even daralutamide in some important parameter in some study. Am I mistaken ? I know Xtandi has higher SEs.

[Tall_Allen in reply to podsart]

There has never been a direct comparison. They've all been tested separately among different groups of patients. Here are the patient-reported outcomes in men with nHSPC:

urotoday.com/conference-hig...

urotoday.com/conference-hig...

[podsart in reply to Tall_Allen]

Thanks

[GP24]

This analysis did not find a difference for early vs late:

redjournal.org/article/S036...