Use of androgen deprivation therapy (ADT) in combination with novel hormonal therapies (NHTs) improves metastasis-free and overall survival among men with high-risk nonmetastatic castration-resistant prostate cancer (nmCRPC), but these regimens are underused in this patient population, according to study findings presented at the European Society for Medical Oncology 2022 (ESMO 2022) Congress in Paris, France.

The findings are from a retrospective study of 2007-2020 data from the Optum electronic health records database. Sumati Gupta, MD, of Huntsman Cancer Institute at the University of Utah in Salt Lake City, and colleagues studied 1572 men with high-risk nmCRPC. As first-line treatment, 48.2% received ADT only, 32.9% received ADT plus first-generation nonsteroidal antiandrogens (NSAAs), 8.8% received ADT plus NHTs, and 10.1% received other regimens. As of 2018-2020, only 21% of patients received ADT plus NHTs (including those with a PSA doubling time of 4 months or less), whereas 44.5% received ADT alone and 26.2% received ADT plus NSAAs. Patients with a PSA doubling time of 10 months or less are at high risk for metastatic disease.

“The study emphasizes the need for real-world data to help highlight deviations from guidelines and quality metrics,” Dr Gupta’s team concluded in a poster presentation.

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Novel hormonal therapies included enzalutamide, apalutamide, and darolutamide, which are androgen receptor inhibitors indicated for treating nmCRPC, as well as abiraterone, which inhibits androgen production in the testes, adrenal glands, and prostate cancer tumors. “Although abiraterone is not indicated for nmCRPC, it was included for completeness and due to the evidence from the IMAAGEN nmCRPC phase 2 trial,” the investigators explained.

In that trial, men with high-risk nmCRPC treated with abiraterone plus prednisone had significant decreases in PSA, with 86.9% experiencing a 50% or greater decline in PSA, according to study findings reported in The Journal of Urology. The median time to radiographic evidence of disease progression was not reached.

Disclosure: The ESMO research was supported by Astellas Pharma and Pfizer. Please see the original reference for a full list of disclosures.


Gupta S, Hong A, El-Chaar NN, et al. Real-world first-line (1L) treatment patterns in patients (pt) with high-risk nonmetastatic castration-resistant prostate cancer (nmCRPC). Presented at: ESMO 2022, September 9-13, Paris, France. Abstract 1410P.

Ryan CJ, Crawford ED, Shore ND, et al. The IMAAGEN Study: Effect of abiraterone acetate and prednisone on prostate specific antigen and radiographic disease progression in patients with nonmetastatic castration resistant prostate cancer. J Urol. 2018;200:344-352. doi:10.1016/j.uro.2018.03.125