63% Of Men Had Better Cancer-Related Outcomes With This Treatment Combo

Prostate cancer surgery removes the prostate, but for men with high-risk disease, it doesn't always end the story.

Cancer can return, spread, or require additional treatment. Researchers are looking for ways to improve outcomes from the start, including combining surgery with medication that blocks hormones cancer cells use to grow.

The substudy included 408 men with high-risk localized or locally advanced prostate cancer, meaning their cancer was confined to the prostate or had begun spreading into nearby tissues.

Researchers randomly assigned 102 men to receive apalutamide, which blocks signals that help prostate cancer cells grow, alongside androgen-deprivation therapy (ADT), which lowers testosterone and other hormones that can fuel the cancer.

They received both treatments over six 28-day cycles before and after surgery. The remaining 306 men had surgery alone.

Researchers tracked cancer-related events, including signs of treatment failure, recurrence, cancer spread, or death.

Three years after treatment, 63% of men who received hormone therapy alongside surgery were free of the tracked cancer-related events, compared with 41% of men who had surgery alone.

The combination group also had a 62% lower risk of experiencing one of these events during the study.

Cancer spread was less common, too.

At three years, 87% of men receiving combination treatment remained free of detectable cancer spread, compared with 78% in the surgery-only group. The combination also reduced the risk of needing additional treatment, such as radiation therapy, by 71%.

There was a trade-off. Serious treatment-related side effects occurred in 31% of men receiving combination therapy, compared with 22% of those who had surgery alone.

The study summary did not specify which side effects occurred.

Removing the prostate doesn't always eliminate every cancer cell. Hormone-blocking medication targets signals that help prostate cancer grow, potentially controlling disease that surgery alone might not fully address.

Earlier research on hormone therapy around prostate surgery produced mixed results, and this approach is not yet established as standard care.

These findings, alongside the main PROTEUS trial, add evidence that combining treatments may benefit some men.

There are still unanswered questions.

The study was open-label, meaning doctors and participants knew which treatment they received, and follow-up was relatively short for assessing long-term cancer outcomes.

For men with high-risk prostate cancer, surgery may be just one piece of the treatment plan. Adding hormone therapy improved several key outcomes in this study, but it also increased serious side effects.