Can enzalutamide plus ADT improve survival for metastatic hormone-sensitive prostate cancer?

For men with metastatic hormone-sensitive prostate cancer (mHSPC), the standard treatment has been androgen deprivation therapy (ADT). Adding enzalutamide, a drug that blocks the androgen receptor, has been studied in large clinical trials. The evidence shows that this combination can help patients live longer and delay cancer progression.

What the research says

The ARCHES trial, a phase 3 study of 1,150 men with mHSPC, found that adding enzalutamide to ADT significantly improved survival. In the final analysis, enzalutamide plus ADT reduced the risk of death by 34% compared to placebo plus ADT (hazard ratio 0.66; 95% CI 0.53 to 0.81; p < 0.001) ⁹. A 2024 post hoc analysis with over 5 years of follow-up reported a 5-year survival probability of 66% with enzalutamide plus ADT versus 53% with ADT alone ³. Patients with high-volume disease who received enzalutamide lived about 36 months longer ³. The combination also improved radiographic progression-free survival, meaning the cancer took longer to worsen on scans ¹⁰. These benefits were seen regardless of whether patients had prior docetaxel chemotherapy or the extent of their disease ¹⁰. The safety profile was consistent with known effects of enzalutamide, and no new safety concerns emerged ³⁹.

What to ask your doctor

• Based on my specific type of metastatic hormone-sensitive prostate cancer, what is the expected benefit of adding enzalutamide to ADT?
• What are the common side effects of enzalutamide, and how can they be managed?
• Are there any other treatment options, such as abiraterone or docetaxel, that might be considered instead of or in addition to enzalutamide?
• How will my response to treatment be monitored, and what follow-up tests will be needed?
• Are there any clinical trials available for my condition that I might be eligible for?