Prostate cancer is the most common cancer in men in the US, with about 15 percent of men diagnosed with localized prostate cancer developing metastatic (widespread and incurable) cancer during their lifetime.

Treatment options for metastatic prostate cancer are improving. Two new studies presented at the American Society of Clinical Oncology (ASCO) annual meeting in Chicago offer hope to patients newly diagnosed with metastatic prostate cancer. We interviewed Dr. Arpit Rao, a renowned prostate cancer expert, faculty member at the University of Minnesota, and Masonic Cancer Center member, to gain insight into these exciting new developments.

The first of these was ENZAMET, a phase 3 trial comparing enzalutamide in combination with androgen deprivation therapy (ADT) versus an older-generation antiandrogen with ADT (control group) for newly diagnosed metastatic prostate cancer. In 1125 men treated across three continents, enzalutamide decreased the risk of disease progression by 71% compared with the control group. Furthermore, at the 3-year mark, 80% of patients receiving enzalutamide were alive compared with 72% of patients in the control group. Enzalutamide was very well tolerated, and side effects, when they did occur, were manageable.

Enzalutamide was already FDA-approved for use in metastatic prostate cancer that has previously progressed on ADT. The ENZAMET trial results lay the foundation for a possible FDA-approval for use in newly diagnosed metastatic prostate cancer, thus changing the treatment landscape.

The second trial evaluated the effectiveness of apalutamide, a drug that works similarly to enzalutamide and directly blocks the testosterone receptor inside the cancer cells. In TITAN, a phase 3 trial of 1052 men with metastatic hormone-sensitive prostate cancer, patients received either apalutamide with ADT, or ADT alone. Apalutamide decreased the risk of cancer progression by 52% and the risk of death by 33% compared with the control group. The treatment was very well tolerated and side effects were manageable.

Apalutamide is not FDA-approved for metastatic prostate cancer currently, but the TITAN trial results make it likely that it will become an option for metastatic prostate cancer patients in the coming future.

“A few extra pills a day could help our patients with metastatic prostate cancer go longer before needing the next treatment and live longer. These treatments also have very manageable side effects and most men continue to feel about the same, if not better, with treatment as they did when they were first diagnosed,” said Dr. Rao. “These patients are often in their 70’s, so getting them to their 80th birthday is a huge milestone, and it has become more possible because of these drugs.”

Men with newly diagnosed prostate cancer already have docetaxel chemotherapy, abiraterone hormonal therapy, and ADT as treatment options. Enzalutamide and apalutamide will give the doctors and patients more choices for this crucial decision. Most of these new treatments block the function of testosterone in cancer cells, but eventually, the cancer cells escape this restriction and the treatments stop working.

When asked, “what’s next?” Dr. Rao shared several interesting projects that his team is working on. “We have a number of novel clinical trials of immunotherapies and targeted therapies to help Minnesotans with prostate cancer in need of newer and better treatments. Many of these trials have already shown promising early results.” 

Dr. Rao is also pioneering a new “liquid biopsy” technique for prostate cancer patients in collaboration with the Thyagarajan lab. He hopes that his work at Masonic Cancer Center, University of Minnesota, one of the best cancer centers in the country, will continue to help Minnesotans with prostate cancer for years to come.

Prostate Cancer Patient Referrals:

Call Clinic Scheduling at 612-676-4200, or Clinical Trials team at or 612-624-2620 to get started.