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Content Update

July 22, 2018

Advances in Treatment of Nonmetastatic Prostate Cancer: In 2018, the FDA approved the antiandrogens apalutamide (Erleada®) and enzalutamide (Xtandi®) for treatment of men with nonmetastatic, castration-resistant prostate cancer. These are the first agents approved for this indication. The results of two Phase 3 trials showed that men with nonmetastatic castration-resistant prostate cancer who were at high risk for developing metastases (defined as a PSA doubling time of 10 months or less) had significantly improved metastasis-free survival when treated with one of the antiandrogens vs. placebo. These results suggest that starting antiandrogen therapy earlier in the course of disease is better than waiting until the appearance of metastases. Longer follow-up is needed to determine the effect of antiandrogen therapy on overall survival.


For the chapter in the Wells Handbook, please go to Chapter 64. Prostate Cancer.



  • image Prostate cancer is the most frequent cancer in men in the United States. African American ancestry, family history, and increased age are the primary risk factors for prostate cancer.

  • image Prostate-specific antigen can be used to detect prostate cancer at early stages, predict outcome for localized disease, define disease-free status, and monitor response to androgen-deprivation therapy (ADT) or chemotherapy for advanced-stage disease.

  • image The prognosis for prostate cancer patients depends on the histologic grade, the tumor size, and the disease stage. More than 85% of patients with stage A1 disease but less than 1% of those with stage D2 can be cured.

  • image ADT with a luteinizing hormone-releasing hormone (LHRH) agonist plus an antiandrogen should be used prior to radiation therapy for patients with locally advanced prostate cancer to improve outcomes over radiation therapy alone.

  • image ADT, with either orchiectomy, an LHRH agonist alone or an LHRH agonist plus an antiandrogen (combined hormonal blockade), can be used to provide palliation for patients with advanced (stage D2) prostate cancer. The effects of androgen deprivation are most pronounced in patients with minimal disease at diagnosis.

  • image Antiandrogen withdrawal, for patients having progressive disease while receiving combined hormonal blockade with an LHRH agonist plus an antiandrogen, can provide additional symptomatic relief. Mutations in the androgen receptor can cause antiandrogen compounds to act like receptor agonists.

  • image Chemotherapy, with docetaxel and prednisone improves survival in patients with castrate-refractory prostate cancer and is considered a first-line therapy option for these patients. Other effective agents include enzalutamide and abiraterone.

Prostate cancer is the most commonly diagnosed cancer in American men.1 For most men, prostate cancer has an indolent course, and treatment options for early disease include expectant management, surgery, or radiation. With expectant management, patients are monitored for disease progression or development of symptoms. Localized prostate cancer can be cured by surgery or radiation therapy, but advanced prostate cancer is not yet curable. Treatment for advanced prostate cancer can ...

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