Abstract
Non-metastatic castration-resistant prostate cancer is a heterogeneous disease that can have an aggressive course in high-risk patients. In recent years, three positive trials with novel androgen receptor antagonists (ARTA agents) have been published, that specifically enrolled patients with high-risk castration-resistant prostate cancer.
In agreement, all of them showed prolongation of metastasis free survival, with an effect on overall survival also demonstrated in at least two of them. All three drugs (apalutamide, darolutamide, enzalutamide) had similar clinical benefit.
Treatment decisions should be based on potential adverse effects in the context of the patient's disease and comorbidities. Studies have used conventional imaging methods to detect metastatic disease when appropriate.
Nowadays, in the prostate specific membrane antigen positron emission tomography (PSMA PET) era, the castration-resistant prostate cancer group may recruit those who will also benefit from radiotherapy in the case of oligometastases, oligoprogression or oligorecurrence.