Treatment De-Escalation: Strategies to Optimize Risk/Benefit in Advanced Prostate Cancer

A. Edward Yen, MD, Assistant Professor of Hematology and Oncology, Baylor College of Medicine, Houston, Texas, outlines evidence supporting selective reduction of therapy intensity after years of treatment escalation in metastatic disease. Dr. Yen reviews landmark intensification trials, including CHAARTED, STAMPEDE, LATITUDE, TITAN, PEACE-1, and ARASENS, and contrasts their survival benefits with toxicity data showing increased cardiovascular, skeletal, and metabolic risks associated with long-term use of androgen-receptor pathway inhibitors (ARPIs). He revisits SWOG 9346 and subsequent analyses demonstrating that deep prostate-specific antigen (PSA) response and low-volume disease predict more prolonged survival and potential tolerance for intermittent therapy. He discusses the ORIOLE study, which demonstrates that metastasis-directed radiotherapy delays systemic treatment. Additionally, he mentions EMBARK, where the combination of enzalutamide and androgen-deprivation therapy (ADT) enabled longer treatment suspensions, and ArteraAI, which predicts which patients benefit from short-term ADT with radiation. Dr. Yen notes that precision oncology is reshaping prostate-cancer management by identifying patients who can safely de-escalate therapy while maintaining durable control and quality of life. Don't forget to join the GRU Community: https://grandroundsinurology.com/regi... Follow us on Twitter/X: https://x.com/GRUrology And like and subscribe to us here on YouTube! #ProstateCancer #Oncology #TreatmentDeEscalation #PrecisionMedicine #GrandRoundsInUrology