Impact of intensified androgen blockade in patients with high-risk biochemically relapsed castration-sensitive prostate cancer

A recent study showed that intensified AR blockade for a finite period extends prostate-specific antigen progression-free survival (PSA-PFS) while maintaining a manageable safety profile, without negatively impacting the time needed for testosterone recovery. This study’s findings were published in the Journal of clinical oncology.

The PRESTO trial was a randomized, open-label, phase III study that involved 503 patients diagnosed with biochemically recurrent prostate cancer (BRPC) and PSA doubling time of 9 months or less. Patients were randomly divided into one of three groups in a 1:1:1 ratio. These groups consisted of a 52-week treatment course with ADT (androgen-deprivation therapy) control, ADT combined with apalutamide, or ADT combined with apalutamide and AAP (abiraterone acetate plus prednisone). The primary endpoint of the trial was to evaluate PSA-PFS, which was defined as having a serum PSA level exceeding 0.2 ng/mL after the completion of the assigned treatment.

The median PSA level was determined to be 1.8 ng/mL (IQR, 1.0-3.6). During the initial planned interim analysis, it was observed that both experimental groups exhibited a significant prolongation in PSA-PFS when compared to the control group (median, ADT + apalutamide was 24.9 months vs 20.3 months for ADT alone; median, ADT + apalutamide + AAP was 26.0 months vs 20.0 months for ADT alone). There was no notable difference in the median time for testosterone recovery across the different treatment arms.

The above results demonstrated that the use of intensified AR blockade for a finite period has been found to PSA-PFS while maintaining a manageable safety profile and not interfering with testosterone recovery time. Consideration should be given to adding apalutamide to androgen deprivation therapy in high-risk BRPC patients.