Can enzalutamide be used in hormone-dependent prostate cancer?

Enzalutamide (Enzalutamide) is an androgen receptor (AR) antagonist, mainly used to treat castration-resistant prostate cancer (CRPC) and metastatic hormone-sensitive prostate cancer (mHSPC). It inhibits the nuclear translocation of androgen receptors and reduces the proliferation and survival of prostate cancer cells by blocking the binding of androgens to their receptors. Enzalutamide has been widely used to prolong patient survival and improve symptoms in the castration-resistant phase.

Enzalutamide has also been studied and used for hormone-dependent prostate cancer (ie, hormone-sensitive prostate cancer, HSPC). Clinical studies have shown that enzalutamide combined with androgen deprivation therapy (ADT) can significantly delay disease progression and improve progression-free survival (PFS) and overall survival (OS). Therefore, the U.S. Food and Drug Administration has approved enzalutamide for patients with metastatic hormone-sensitive prostate cancer (mHSPC) who remain responsive to androgen deprivation therapy (ADT).

However, the use of enzalutamide in non-metastatic hormone-dependent prostate cancer (nmHSPC) has not been fully established. Currently, the standard treatment is still ADT, while the use of new androgen receptor inhibitors (such as enzalutamide or abiraterone) is more concentrated in metastatic disease. For high-risk locally advanced HSPC patients, whether to use enzalutamide requires comprehensive consideration of clinical risk factors and physician evaluation.

In general, enzalutamide can be used in some patients with hormone-dependent prostate cancer, especially HSPC with metastasis (mHSPC). Future studies may further explore its role in the treatment of earlier-stage prostate cancer, but currently its main indication remains in metastatic or castration-resistant prostate cancer.

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