New Data Influencing your Treatment Decisions in mCSPC

This segment delves into the evolving concept of treatment holidays and therapy reinitiation in prostate cancer management, guided by findings from the EMBARK trial. Panelists discuss how EMBARK—originally designed before widespread PSMA PET imaging—demonstrated impressive long-term outcomes, including 80% survival at eight years, in patients treated with enzalutamide plus ADT. Expert panalists outlines the trial’s structured approach: patients received nine months of combination therapy, discontinued treatment upon achieving PSA <0.2, and resumed therapy only when PSA rose to specific thresholds (2 ng/mL post-surgery or 5 ng/mL post-radiation). This protocol showcased the potential for durable disease control with intermittent therapy, suggesting opportunities for reducing treatment burden while maintaining efficacy. The discussion highlights ongoing questions around patient selection, optimal timing for therapy resumption, and the balance between intensification and de-intensification strategies—paving the way for more individualized, biology-driven management of prostate cancer.

Panelists noted that abiraterone, apalutamide, and enzalutamide demonstrate overall survival benefits, while darolutamide primarily delays progression. They discussed side-effect profiles and monitoring needs—highlighting the need for liver function monitoring and steroid co-administration with abiraterone—and emphasized that treatment selection often depends on balancing efficacy, toxicity, and clinician comfort.