Breaking Down Advancements in Prostate Cancer Care

Following the 2025 European Society of Medical Oncology (ESMO) Congress, Dr. Joshua Sabari, an assistant professor in the Department of Medicine at NYU Grossman School of Medicine and director of High Reliability Organization Initiatives at Perlmutter Cancer Center, sat down with Dr. Chandler Park, a medical oncologist specializing in Genitourinary Medical Oncology at the Norton Healthcare Institute in Louisville, Kentucky, to discuss recent advances in prostate cancer care.

Their conversation focused on the EMBARK trial, which evaluated Xtandi (enzalutamide), both as monotherapy and in combination with leuprolide (Lupron), for patients with nonmetastatic or biochemically recurrent prostate cancer.

Park described the EMBARK trial as a practice-changing, phase 3 study that addressed a critical unmet need for men whose prostate-specific antigen (PSA) levels rise within nine months following surgery or radiation. The goal was to determine whether early intervention with enzalutamide-based therapy could prevent disease progression and improve survival outcomes. According to Park, the results demonstrated a significant overall survival benefit for patients treated with the combination of enzalutamide and leuprolide, as compared with leuprolide alone.

Importantly, he highlighted that this study is the first phase 3 trial to validate the use of intermittent therapy in this patient population. Patients in the combination arm received treatment for approximately 36 to 37 weeks. If their PSA dropped below 0.2, they were able to stop therapy. On average, PSA levels remained suppressed for 18 to 24 months, allowing many men to enjoy extended treatment-free intervals without side effects. This approach, Park explained, is now considered a new standard of care for patients with biochemical recurrence after radiation or radical prostatectomy.

Sabari concluded the discussion by asking how common biochemical recurrence is after definitive therapy. Park noted that, importantly, 40% to 50% of patients experience recurrence following surgery or radiation, emphasizing the need for multidisciplinary evaluation and individualized treatment planning.

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