Transforming Prostate Cancer Treatment: Novel Therapies and Surgical Advances

Prostate cancer treatment is undergoing a remarkable transformation, as novel therapies challenge established norms and offer promising outcomes for patients facing metastatic hormone-sensitive prostate cancer (mHSPC).

Emerging evidence is shifting the mHSPC paradigm, as Enzalutamide added to androgen deprivation therapy is extending radiographic progression-free survival and deferring castration resistance, as shown in the matching-adjusted indirect comparison (not a head-to-head RCT; indirect methodology with limitations).

This efficacy surge is tempered by a renewed focus on safety, since Darolutamide’s favorable toxicity profile is translating into higher treatment adherence and better quality of life, as highlighted by key safety data from the phase III Darolutamide analysis (the ARAMIS trial) per current NCCN guidelines for mHSPC.

Emerging data suggest low-dose abiraterone at 250 mg with food maintains robust PSA control without increasing toxicity and achieves significant cost savings, as demonstrated in the prospective low-dose Abiraterone trial, noting that this regimen remains under investigation and is not yet standard per current guidelines.

A related challenge emerges in localized disease management, where Aquablation’s robotic waterjet ablation delivers precise tissue resection with reduced blood loss and accelerated recovery compared to traditional radical prostatectomy; preliminary results from the phase II WATER IV trial published in the Journal of Urologic Oncology underscore these benefits.

As these innovations converge—from radiographic gains with Enzalutamide to cost-effective dosing strategies and refined surgical techniques—clinicians are empowered to tailor prostate cancer care with unprecedented precision.

Key Takeaways:

• Enzalutamide and Darolutamide are setting new benchmarks in mHSPC by balancing efficacy with safety considerations.
• Low-dose abiraterone preserves therapeutic outcomes while reducing treatment costs.
• Aquablation demonstrates the move toward minimally invasive prostate surgery with faster recovery.