Focus on Transitional Disease: A Critical Interval to Delay Progression of Prostate Cancer

Recognizing the transition state-the period before these events-is crucial to extending survival and improving quality of life. [...]nmCRPC, mCSPC, and oligometastatic disease are not just steps along a continuum, but critical points for intervention and clinical studies to delay mCRPC (Figure 1). Earlier intervention via evaluation with these NGI modalities will reduce the time to discovering metastatic disease and will provide a potential increase in OS. In other words, this strategy delayed progression to mCRPC, and it subsequently demonstrated a statistically significant benefit in median OS compared with placebo plus ADT (73.9 vs 59.9 months with apalutamide; 67.0 vs 56.3 months with enzalutamide; medians for OS not reached with darolutamide).1 Based on these findings and a tolerable adverse effect (AE) profile compared with ADT alone, all 3 agents are now approved by the FDA to treat patients with nmCRPC.