Given the superiority of ADT+enzalutamide over ADT alone demonstrated in the ARCHES and PROSPER trials, would you recommend it in the definitive setting for men with high-risk castrate-sensitive prostate cancer?

The quick answer is: No.

There is no level 1 evidence that next gen AR-signaling inhibitors (ASI) improve DMFS or OS in high risk localized prostate cancer. Multiple trials are ongoing or maturing in followup, nearly all in combination with RT.

Given that most contemporary high risk studies show ~10% ...

There is still some clinical heterogeneity in patients with high-risk prostate cancer, who are castration sensitive. Considering financial resource stewardship, it is imperative that we be circumspect with utilization of expensive therapies. This is especially true when there be when there may be l...