By Alexander Evgenievich Abolmasov, Oncologist and Medical Director of the Dr. Laskov Clinic
At a recent ASCO Genitourinary Cancers Symposium, researchers unveiled new data on prostate cancer therapies that could shape future treatment decisions. While the results are encouraging, experts caution that more evidence is needed before changing clinical practice.
Radionuclide Therapy with Lutetium
The ENZA-P study tested enzalutamide alone versus enzalutamide combined with lutetium in men with castration-resistant prostate cancer. Early results suggested a survival benefit with the combination. Yet, as Dr. Abolmasov notes, the trial was only phase l, and previous lutetium studies such as VISION and PSMAfore have faced methodological challenges.
Conclusion: Lutetium therapy remains promising but unproven.
Antiandrogen Effectiveness in Hormone-Sensitive Cancer
All antiandrogen drugs showed similar effectiveness overall. However, abiraterone was less effective in patients aged 75 and older.
Implication for patients: Older men may benefit more from alternative antiandrogen therapies.
Radiation vs Surgery in High-Risk Localized Disease
Radiation therapy reduced the risk of distant metastases compared to surgery. But deaths without metastases were higher in the radiation group, raising questions about survival outcomes. Importantly, about 80% of men who underwent surgery required additional treatment afterward.
Key takeaway: Surgery alone is rarely sufficient in high-risk cases; multimodal therapy is often necessary.
The ASCO GU 2025 findings highlight both progress and caution in prostate cancer care. Lutetium therapy may become a valuable option, antiandrogen choice should consider patient age, and surgery for high-risk disease almost always requires follow-up treatment.
Dr. Alexander Evgenievich Abolmasov emphasizes that while these studies bring hope, patients should consult their doctors to understand what the evidence means for their individual situation.
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