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

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.

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.