Re: Outcome Following Active Surveillance of Men with Screen-Detected Prostate Cancer. Results from the Göteborg Randomised Population-Based Prostate Cancer Screening Trial

Abstract

Editorial Comment: The treatment of castration resistant prostate cancer is arguably the most rapidly evolving facet of prostate cancer care in the last 20 years. We have gone from a palliative art to a strategic science involving a number of novel agents with differing, and potentially complementary, mechanisms of action. With the recent Food and Drug Administration approval of second-line hormonal agents, immunotherapy and chemotherapy for castration resistant disease, future decision making will focus not on "what to offer," but instead "what to offer first." Urologists must retain a strong understanding of the biology of these agents and their therapeutic evolution so as to remain principal in the treatment of prostate cancer.Traditional androgen receptor targeting agents have focused on removal of ligand or disruption of ligand binding with the receptor. MDV3100, or enzalutamide, is a competitive inhibitor of androgen receptor ligand binding with greater affinity for the receptor and greater potency than competitive inhibitors previously available. Additionally the agent is distinct from conventional antiandrogens in that it appears to prevent translocation of the receptor to the nucleus, disrupts interaction with transcriptional activators and thereby prevents the receptor complex from activating target genes necessary for growth. In this phase III study of men who have previously progressed while on cytotoxic chemotherapy, enzalutamide demonstrates an improvement in median survival, reduction in PSA and delay in skeletal events among those treated. Samir S. Taneja, M.D.