Freedland explores how enzalutamide’s role has expanded from advanced settings to earlier use in high-risk, biochemically recurrent prostate cancer. He discusses the clinical rationale for early initiation, particularly for urologists less familiar with systemic therapy, and compares enzalutamide with other androgen receptor pathway inhibitors in this population.
This segment centers on the landmark EMBARK trial, which demonstrated a significant overall survival benefit with enzalutamide plus leuprolide. Freedland discusses the clinical implications of these findings, how they may alter treatment guidelines, and the importance of counseling asymptomatic patients about the benefits of early systemic therapy.
Freedland reviews enzalutamide’s long-term safety profile, drawing from the EMBARK, ARCHES, and ENZAMET trials. He explains strategies for managing adverse events, balancing efficacy with tolerability, and comparing safety outcomes across other androgen receptor pathway inhibitors to help clinicians personalize care.
This discussion emphasizes practical implementation. Freedland outlines how urologists and medical oncologists can collaborate to ensure timely therapy initiation and shares insights into patient- and disease-specific factors that drive the choice of androgen receptor inhibitor in clinical practice.
The series concludes with a forward-looking discussion on ongoing research and unresolved questions about long-term enzalutamide therapy. Freedland reflects on evolving treatment paradigms and offers key takeaways for practicing urologists to help guide their management of men with high-risk, biochemically recurrent prostate cancer.
