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New Prostate Cancer Treatment Approach Slows Progression Without Hurting Quality of Life, Study Finds

Ronald Chen, MD, MPH

June 03, 2024

Study reveals significant improvement in reducing prostate cancer progression without compromising quality of life.

The 5-year survival rate for local or regional prostate cancer is nearly 100%, but the rate drops to 32% if it has spread (metastasized) to other parts of the body. When prostate-specific antigen (PSA) levels begin to rise again after surgery, known as biochemical recurrence, it often indicates a higher risk of the cancer spreading to other parts of the body. About half of men diagnosed with local prostate cancer will get metastatic cancer during their lifetime.

A pioneering clinical trial led by Ronald Chen, MD, MPH, chair and professor of Radiation Oncology and associate director for health equity at The University of Kansas Cancer Center, suggests that a novel treatment approach may improve outcomes. Dr. Chen recently presented his findings at the annual meeting of the American Society of Clinical Oncology, or ASCO, which took place May 31 to June 4, 2024. ASCO is the biggest cancer conference in the world, convening more than 40,000 people each year.

The phase 3 clinical trial, known as PRESTO, looked at 503 prostate cancer patients who, despite radical prostatectomy and most having received radiation therapy, still experienced a recurrence and had quickly rising PSA levels, indicating an aggressive disease. Commonly, these patients are treated with androgen deprivation therapy (ADT), or commonly called hormonal therapy. The researchers tested if increasing this treatment could improve outcomes.

Study participants were divided into three groups randomly, each receiving a different treatment regimen. One group received standard ADT, another received ADT plus apalutamide (an androgen receptor antagonist) and the third received ADT plus apalutamide plus abiraterone acetate plus prednisone (AAP), another treatment combination. The primary goal of the study was to assess whether increasing treatment resulted in better controlling prostate cancer by reducing progression. A secondary goal was to assess if increasing treatment negatively impacted patients’ quality of life.

“The results were striking,” Dr. Chen said. “Both experimental treatment groups showed significantly reduced prostate cancer progression compared to the control group (standard ADT), indicating that the intensified treatment approach was highly effective. Just as importantly, increasing treatment by adding apalutamide to ADT did not significantly impact patient quality of life. This study assessed how different treatments impacted patients’ sexual function, energy level, hot flashes and overall quality of life. While standard ADT impacted each of these areas, adding apalutamide did not significantly worsen the side effects.”

The study also found that the new treatment approach did not delay the recovery of testosterone levels, which is crucial for maintaining overall health and quality of life in men. “This is an important trial for men with aggressive prostate cancer who have cancer progression after both radical prostatectomy and salvage radiation therapy. These results show that we can increase treatment by adding apalutamide to ADT to better control prostate cancer, without negatively impacting quality of life,” Dr. Chen said. “It is with clinical trials like this that we can continue to advance treatment for men with prostate cancer.”

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