SPARTAN, PROSPER and ARAMIS: 2020 Update
Non-metastatic castration-resistant prostate cancer (nmCRPC) affects at least 110,000 patients in the United States each year, comprises 1% to 2% of prostate cancers worldwide, and is a significant risk factor for progression to overt metastatic disease and cancer-related death.1,2 Amidst the many challenges of 2020, a bright spot has been the reporting of final overall survival (OS) data from the registrational SPARTAN, PROSPER, and ARAMIS trials, which confirm that for appropriately selected patients with high-risk nmCRPC, treatment with a next-generation androgen receptor (AR) inhibitor, whether apalutamide, enzalutamide, or darolutamide, significantly prolongs both metastasis-free survival (MFS) and overall survival (OS). It is remarkable that we now have three approved therapies for a disease state wherein, just three years ago, there was no level 1 evidence for an approved therapeutic. Herein, I will review the new efficacy and safety data and clinical implications for these recently approved nmCRPC agents.