Rahul Aggarwal, MD, on combination treatment approaches in PSA-recurrent prostate cancer

The phase 3 PRESTO trial (NCT03009981) assessed combined androgen signaling blockade for a finite treatment period of 52 weeks in patients with high-risk biochemically relapsed prostate cancer.

Final results from the study were recently presented at the 2025 European Society for Medical Oncology (ESMO) Congress in Berlin, Germany, showing that the combination of androgen deprivation therapy (ADT) plus apalutamide prolonged metastatis-free survival (MFS) per 48-month restricted mean survival time. Data also demonstrated that the combination lengthened the time to castration-resistance and time to subsequent treatment.¹

In an interview with Urology Times®, presenting author Rahul Aggarwal, MD, shared the key takeaways from these results as well as remaining questions. Aggarwal is a genitourinary medical oncologist at the University of California, San Francisco.

Aggarwal began by interpreting the results from PRESTO in the context of the EMBARK study, which showed that the combination of ADT plus enzalutamide extended MFS and overall survival compared with ADT alone in patients with biochemically recurrent prostate cancer.

“I think what those 2 trials tell us is that when a clinician decides that systemic therapy is needed for patients with PSA-recurrent prostate cancer, that combination therapy given for a finite period of time improves outcomes compared to giving ADT monotherapy,” Aggarwal explained.

However, he also noted that neither study was conducted in the era of widespread PSMA-PET imaging.

“How do we put these data in the context of metastasis-directed radiation based on PET and some of the non-ADT containing treatments like radioligand therapy [and] immunotherapies? Can those slot into the biochemically relapsed setting and maybe delay the need for even the start of hormone therapy? Those are clinically important questions [that] ongoing studies trying to answer,” he concluded.

REFERENCE

1. Aggarwal R, Hillman D, Xiao H, et al. Final results from PRESTO: A phase III open-label study of combined androgen blockade in patients (pts) with high-risk biochemically relapsed prostate cancer (BRPC) (AFT-19). Presented at: 2025 European Society for Medical Oncology Congress. October 17-21, 2025. Berlin, Germany. Abstract LBA88. https://s3.eu-central-1.amazonaws.com/m-anage.com.storage.esmo/static/esmo2025_abstracts/LBA88.html.pdf