Editing Castrate-Resistant Prostate Cancer (section)

===== Darolutamide =====
* '''See [[Hormonal Therapy|Hormonal Therapy Chapter Notes]]'''

====== <span style="color:#ff00ff">ARAMIS ======
* Population: 1509 men with nonmetastatic, CRPC and a PSA doubling time ≤10 months
* Randomized to darolutamide (600 mg [two 300-mg tablets] twice daily) vs. placebo
* Primary outcome: metastasis free survival
* Results:
** Metastasis-free survival improved by 22 months in the darolutamide arm (40 darolutamide vs. 18 months placebo)
** Overall survival significantly improved by 6% at 3 years in the darolutamide arm (83% darolutamide vs. 77% placebo)
** Darolutamide was also associated with benefits with regard to all secondary end points, including overall survival, time to pain progression, time to cytotoxic chemotherapy, and time to a symptomatic skeletal event.
* [https://www.ncbi.nlm.nih.gov/pubmed/30763142 Fizazi, Karim, et al."Darolutamide in nonmetastatic, castration-resistant prostate cancer." New England Journal of Medicine 380.13 (2019): 1235-1246.]
* [https://pubmed.ncbi.nlm.nih.gov/32905676/ Fizazi, Karim, et al."Nonmetastatic, castration-resistant prostate cancer and survival with darolutamide." ''New England Journal of Medicine'' 383.11 (2020): 1040-1049.]
'''Detection of metastases and imaging in untreated patients§'''
* '''Recommended screening for patients who progress on ADT without evidence of distant metastases:'''
** '''Modalities:'''
*** '''Bone scans''' for bone metastases
*** '''Imaging of the chest/abdomen/pelvis''' to monitor for lymph node and visceral metastases/progression
**** Imaging techniques most commonly used include abdominal/pelvic CT and chest X-ray.
**** The role of positron-emission tomography (PET) such as PSMA-PET are still unclear and the benefits unknown
** '''Frequency of imaging'''
*** '''PSADT <10 months or PSA >20: every 3–6 months'''
**** At high risk for developing metastases earlier
*** '''PSADT > 10 months: every 6–12 months'''
** If metastases are detected, patients should be treated based on metastatic CRPC recommendations.