Radioligands and ADT alternatives emerge in prostate cancer treatment

In this video, urologist Jonathan Henderson, MD, of Arkansas Urology in Little Rock, reflects on the significance of the EMBARK trial data presented at ESMO 2025, particularly the findings related to enzalutamide (Xtandi) in patients with biochemical recurrence of prostate cancer. He explains that the trial’s design—featuring multiple treatment arms, including enzalutamide with androgen deprivation therapy (ADT), enzalutamide alone, and the incorporation of treatment holidays for responders—has already influenced his clinical practice. Henderson highlights that patients particularly value the ability to de-escalate therapy and enjoy structured breaks from medication, making the EMBARK data highly actionable and impactful for day-to-day management of recurrent prostate cancer.

Henderson also discusses several broader advances in the prostate cancer landscape. He notes growing excitement around radioligand therapy, particularly lutetium-177 PSMA (Pluvicto). Although currently approved for metastatic castration-resistant prostate cancer in pre- and post-chemotherapy settings, emerging early-phase trials suggest that radioligand therapy may offer progression benefits when used earlier, including in metastatic castration-sensitive disease. This upstream movement is something clinicians have long anticipated, and the presence of a positive initial signal is encouraging.

Beyond radioligands, Henderson points to a number of novel therapeutic categories under investigation. He cites the MEVPRO trials evaluating a new class of agents from Pfizer, as well as a KLK2-targeted therapy trial from Johnson & Johnson—both representing mechanisms distinct from current standards. Importantly, he underscores the hope that future treatments may reduce or even eliminate the need for hormonal therapy. Although ADT is widely used, he stresses that its impact on quality of life can be profound for some patients. The possibility of effectively treating prostate cancer without ADT, he says, would represent a transformative advance and remains an area of strong clinical and scientific interest.