EMBARK: “Unprecedented” Overall Survival

This series offers a deep dive into the changing landscape of prostate cancer therapy, particularly in men with high-risk, biochemically recurrent disease. Freedland begins by tracing the evolution of enzalutamide, detailing its growing role across disease stages and its clinical rationale as a first-line systemic therapy. He explains how advances in trial data and clinical experience have shifted treatment earlier in the disease continuum, highlighting the drug’s value in preventing disease progression and improving survival.

The discussion then turns to the EMBARK trial, whose findings have reshaped expectations for outcomes in this patient population. Freedland underscores the “unprecedented” overall survival benefit observed with enzalutamide plus leuprolide compared with androgen deprivation therapy alone. He interprets these results in the context of patient counseling, guideline development, and payer considerations, emphasizing how early systemic therapy can extend life even in asymptomatic men—a critical message for both urologists and oncologists.

Subsequent segments explore the safety, tolerability, and clinical integration of enzalutamide, as well as future directions in research. Freedland discusses adverse event management, multidisciplinary collaboration between urology and oncology, and key clinical factors that guide the selection among available androgen receptor pathway inhibitors. The series concludes with a forward-looking perspective on unanswered questions and emerging data that may further define enzalutamide’s role in prostate cancer treatment. The result is a comprehensive, practical resource designed to inform real-world decision-making in the evolving nonmetastatic castration-sensitive prostate cancer (nmCSPC) treatment paradigm.