Dr. Morris on Treatment Considerations for CRPC

David Morris, MD, FACS, a urologist at Urology Associates, P.C., discusses choosing the best agent to treat patients with nonmetastatic castration-resistant prostate cancer.

Three androgen receptor inhibitors—apalutamide (Erleada), enzalutamide (Xtandi), and darolutamide (Nubeqa)—have shown similar efficacy in terms of the primary analysis of metastasis-free survival (MFS), explains Morris. All agents have shown about a 2-year benefit in MFS until there is metastasis on imaging in high-risk patients with quickly progressing disease, who have previously been on androgen deprivation therapy and did not have any evidence of metastasis on conventional imaging, says Morris.

The safety profile of each drug will likely determine which drug is best for each patient. Specific exclusion criteria need to be examined, including seizure risk and the tolerance of the medication, according to Morris. Financial toxicity for the patient may also impact the choice, concludes Morris.