Non-metastatic castration-resistant prostate cancer (nmCRPC) indicates a condition characterized by the progression of the prostate-specific antigen without radiographic evidence of distant metastasis on conventional imaging during androgen deprivation therapy (ADT). Recently, 3 phase III trials have shown that the addition of next-generation androgen-receptor inhibitors (ARIs) apalutamide, darolutamide, and enzalutamide to ADT allows patients with high-risk nmCRPC to delay the appearance of metastasis and to obtain long-term clinical benefits. However, the lack of head-to head comparison makes it difficult to choose one among these agents. We reviewed the literature and explained the rationale of the possible therapeutic choices. In any case, the availability of novel ARIs means that patients with nmCRPC have now a new effective treatment option that provides them a renewed hope.
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Article Synopsis
- Prostate cancer is the second most common cancer in men, with various stages ranging from localized to metastatic disease, and treatment for advanced stages typically involves external beam radiotherapy and hormonal therapy for better prognosis.
- Current therapies for non-metastatic castration-resistant prostate cancer (M0 CRPCa) utilize androgen deprivation combined with new drugs, showing promising results in clinical trials for prolonging metastatic-free survival.
- New drug developments, including PARP inhibitors and Lutetium-177, along with ongoing clinical trials for treatments like cabozantinib and CAR T-cell therapy, aim to improve overall survival rates and slow disease progression in advanced prostate cancer cases.
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