Study results affirm effectiveness of evolving prostate cancer therapies

In a recent interview with Urology Times®, Stephen J. Freedland, MD, discussed the findings from a recent study comparing randomized controlled trials and real-world efficacy of prostate cancer treatments.¹ The study compared the outcomes of drugs approved between 2010 and 2019. He was asked, with the rapid evolution of metastatic castration-resistant prostate cancer treatments, how he anticipates these findings might translate to newer therapies approved post-2019, particularly those with novel mechanisms of action.

“The challenge is, from a statistical study design point of view, you need enough years after that drug has been approved to see how it's going to work in the real world…We need to follow patients, so it’s always going to lag by a few years,” said Freedland, a professor of urology at Cedars-Sinai in Los Angeles, California.

He did note, however, “What was reassuring is we looked at drugs with 3 different mechanisms of action. We looked at androgen-targeted therapies. We looked at radiopharmaceuticals, and we looked at immunotherapy. All of them showed similar or better effectiveness in the real world than we saw in the clinical trials. So it's not just AR-targeted therapies. Is that a guarantee that’ll apply to every new drug, every new mechanism action? Of course not. But I think it does give us more confidence than just 1 drug and 1 mechanism of action. It seems to be pretty broad.”

He added, “I think it does give us confidence that clinical trials can predict how these drugs will work in the real world. But ultimately, for each new drug, each new mechanism, you'll need to study it, but it's going to be a few years until we have that level of data.”

REFERENCE

1. Axeen S, Chen AJ, Lakdawalla DN, et al. Do trial benefits predict real-world gains in metastatic castration resistant prostate cancer. JNCI Cancer Spectr. 2025;9(2):pkaf018. doi:10.1093/jncics/pkaf018