As little as five years ago, treatment options for advanced prostate cancer were extremely limited, but as research continues, the outlook is shifting toward longer survival and better quality of life.
Radioligand therapy: PLUVICTO® in the first-line setting
PLUVICTO, an intravenous targeted radioligand therapy, has now been approved for first-line use in the hormone-resistant stage of prostate cancer. Previously, patients had to receive chemotherapy before being eligible for the therapy. Now, they can receive this treatment once their cancer becomes resistant to hormone therapy, broadening access to an effective and well-tolerated option.
Next-generational hormonal therapy: NUBEQA® as a doublet
Another exciting update involves NUBEQA (darolutamide), an androgen receptor signaling inhibitor. This drug was initially approved only for non-metastatic hormone-resistant prostate cancer or in combination with chemotherapy for metastatic hormone-sensitive disease. It is now approved as a doublet therapy, meaning patients with metastatic hormone-sensitive prostate cancer no longer need chemotherapy to receive NUBEQA. An added benefit of NUBEQA is that it has less potential for crossing the blood-brain barrier as well as fewer drug-drug interactions, which often translates into fewer side effects for patients taking the drug.
Clinical trial research in advanced prostate cancer
CAPItello-281: Precision targeting with capivasertib
Ongoing research continues to expand treatment options. The Phase 3 CAPItello-281 trial tested the AKT inhibitor capivasertib (TRUQAP®) combined with abiraterone and androgen deprivation therapy in men with newly diagnosed PTEN-deficient metastatic hormone-sensitive prostate cancer. The study showed a statistically significant improvement in radiographic progression-free survival compared with standard therapy, with an early but not yet mature trend toward improved overall survival. Side effects were consistent with known profiles of the drugs, and longer follow-up will clarify survival outcomes and long-term safety.
Bispecific antibodies: The next wave of immunotherapy
Early-phase but highly innovative, bispecific antibodies represent a new approach to harnessing the immune system. These engineered antibodies can bind to two targets simultaneously, such as a tumor antigen and an immune cell receptor, redirecting immune cells to attack cancer. Current trials are testing bi-specifics in the metastatic castration-resistant setting and are still in early-phase clinical trials.
Expanding horizons for radioligand therapy
Beyond PLUVICTO’s recent approval, research into radioligand therapies is moving into earlier disease stages, including metastatic hormone-sensitive prostate cancer and oligometastatic disease, when there are only a few sites of spread. Investigators are also exploring whether lower or less frequent dosing can maintain efficacy while reducing toxicity. In addition, novel agents targeting markers beyond PSMA are in development, offering the possibility of multi-targeted approaches. While not all trials will ultimately lead to clinical use, the range of studies reflects strong momentum and growing optimism.
Conclusion
Less than a decade ago, treatment for advanced prostate cancer largely relied on chemotherapy and androgen deprivation therapy. Today, patients benefit from an expanding toolkit that includes novel hormone therapies, targeted radioligands, precision inhibitors and emerging immunotherapies. Each advance represents not only progress in science but also the possibility of giving patients more time, better outcomes and renewed hope.
Learn more about prostate cancer treatment at Northside.
