Therapie des nicht-fernmetastasierten CRPC: Androgenrezeptorinhibition als neuer Therapiestandard beim nicht-fernmetastasierten kastrationsresistenten Prostatakarzinom mit hohem Metastasierungsrisiko

In patients with nonmetastatic castration-resistant prostate cancer (nmCRPC or M0CRPC) at high risk of progression (defined as prostate-specific antigen [PSA] doubling time ≤ 10 months), new androgen receptor inhibitors (ARI) in combination with continued androgen deprivation therapy (ADT) are considered the new standard of care. Apalutamide, enzalutamide, and darolutamide have been approved on the basis of improved metastasis-free survival (MFS) in the respective large pivotal studies SPARTAN, PROSPER and ARAMIS and now, with a longer follow-up period, were able to show also a statistically significant and clinically relevant overall survival advantage compared to placebo plus ADT. The data available to date indicate that all three ARIs are comparably effective, accompanied by good tolerability. Moreover, the generally good quality of life of this patient population, who usually has no tumor-related symptoms, was maintained. Comparative head-to-head trials of the three approved substances are not available yet.