Defining The Role for Hormone Therapy in Biochemically Recurrent Prostate Cancer: What Counts as a Win for Patients?

Abstract

Purpose of review: We evaluate unique clinical and drug development challenges in biochemically recurrent (BCR) prostate cancer. We examine risk stratification, critically appraise trials, and outline ongoing and future development of hormonal and non-hormonal options. We provide guidance for patient communication and examine how trial design may or may not reflect patient values.

Recent findings: EMBARK established a potential role for enzalutamide with or without androgen deprivation therapy for certain patients with BCR, but questions remain about the study design and optimal usage. BCR is a heterogeneous condition with generally favorable long-term outcomes. Hormonal therapies are highly effective in suppressing-but not curing-micrometastatic disease, and are also highly effective when reserved for macrometastases, following surveillance. Ongoing studies are examining whether hormonal therapies add to metastasis-directed therapies and whether non-hormonal therapies may offer alternatives or combinations. Careful attention to trial design and endpoints will be essential for accurately measuring benefits and trade-offs.