Could Adding a Targeted Therapy Before Surgery Change Prostate Cancer Care?
Key Takeaways:
- A large international trial tested whether adding apalutamide to hormone therapy and surgery could improve outcomes for people with high‑risk prostate cancer
- The study found that this approach led to longer periods without the cancer returning and more tumor shrinkage before surgery
- The findings suggest this treatment sequence may offer a new option for people at greater risk of relapse
New findings presented at the American Society of Clinical Oncology Annual Meeting point to a possible shift in how doctors treat high-risk prostate cancer, a fast-growing form of the disease that is more likely to return after surgery. In a large international study, adding the targeted therapy apalutamide to standard hormone-lowering treatment before and after prostate removal helped people live longer without their cancer coming back or spreading.
Why High-Risk Prostate Cancer Remains Challenging
Prostate cancer is the second leading cause of cancer death among men in the United States, and high-risk cases are especially challenging. Eve
n after a radical prostatectomy, surgery to remove the entire prostate gland and seminal vesicles, cancer returns in about half of patients. Doctors often use androgen deprivation therapy to slow the disease by reducing hormones that fuel tumor growth. But many people still face relapse.
Inside the PROTEUS Trial Results
The phase 3 PROTEUS study followed more than 2,100 participants across 18 countries. Everyone had surgery and received androgen deprivation therapy. Half also received apalutamide, a medicine that blocks the androgen receptor pathway. After a median of just over five years of follow‑up, those who got apalutamide had a longer period before the cancer returned or spread. They were also far more likely to have major tumor shrinkage by the time of surgery.
Julio Pow-Sang, MD
Julio Pow-Sang, MD, chair of the Genitourinary Oncology Department at Moffitt Cancer Center, says the results could influence how doctors think about treatment sequencing. “For people with high-risk prostate cancer, the biggest challenge is preventing the cancer from coming back after surgery,” he said. “Seeing a meaningful improvement in both tumor response and time without recurrence suggests this approach may offer another tool for patients who face a higher chance of relapse.”
Trial investigators noted that side effects were somewhat more common in the apalutamide group, including rashes and higher rates of severe events. Still, most side effects were manageable, and the overall safety profile was consistent with what doctors expect from this class of drugs.
What Comes Next
Pow-Sang adds that the findings raise important questions about how to personalize care. “Not every patient with high-risk disease is the same,” he said. “The next step is understanding which biological features predict who benefits most from adding a targeted therapy like apalutamide.”
The study team plans further analyses to explore biomarkers and patient-reported outcomes, which could help refine treatment decisions in the future.
