Dr. Garg on Selecting Between Antiandrogen Agents in Nonmetastatic CRPC

Natasha Garg, DO, medical oncologist, hematologist, and assistant clinical professor in the Department of Medical Oncology and Therapeutics Research at City of Hope, discusses selecting between antiandrogen agents in nonmetastatic castration-resistant prostate cancer (CRPC).

Without comparative data, any of the approved antiandrogen agents—enzalutamide (Xtandi), darolutamide (Nubeqa), and abiraterone acetate (Zytiga)—would be suitable for eligible patients with nonmetastatic CRPC, says Garg. However, treatment selection should not be a one-size-fits all approach and choosing between these agents should be based on individual patient characteristics, Garg explains.

Additionally, some patients with nonmetastatic disease and a prostate-specific antigen (PSA) doubling time of less than 10 months may not require treatment with an antiandrogen agent, says Garg. For example, young, fit patients with an 11-month PSA doubling time and high-risk features, such as a high Gleason score, should be considered for treatment, Garg says. Conversely, elderly, frail patients with a limited life expectancy may benefit more from observation based on the potential toxicity and cost of treatment, Garg explains.