How to cite: Javier-DesLoges J. “Recurrent Prostate Cancer: Enzalutamide Monotherapy and Alternatives.” Grand Rounds in Urology. November 13, 2025. Accessed Oct 2026. https://grandroundsinurology.com/recurrent-prostate-cancer-enzalutamide-monotherapy-and-alternatives/
Summary
Juan Javier-DesLoges, MD, MS, FACS, Assistant Professor of Urology, University of California, San Diego, San Diego, California, focuses on the management of recurrent prostate cancer and examines the role of enzalutamide monotherapy alongside alternative management strategies. Dr. Javier-DesLoges explains that the foundation of treatment decisions begins with careful risk stratification, describing how grade group, stage, nodal involvement, prostate-specific antigen (PSA) kinetics, timing of recurrence, and prior treatment history help determine which patients are higher risk and require more aggressive approaches.
Dr. Javier-DesLoges emphasizes that treatment of biochemical recurrence should mirror the thorough approach used in newly diagnosed prostate cancer. He describes reassessing PSA to determine doubling time, performing biopsy when the prostate remains, evaluating the seminal vesicles when indicated, obtaining magnetic resonance imaging (MRI) for local assessment, and incorporating advanced positron emission tomography (PET) imaging to evaluate nodal or metastatic involvement.
Management options extend beyond systemic therapy. Dr. Javier-DesLoges reviews observation and multiple salvage local therapy options, including radiation, focal approaches, and salvage prostatectomy. He highlights data comparing different salvage modalities and notes considerations around toxicity and outcomes.
Dr. Javier-DesLoges shifts his focus to systemic therapy, specifically enzalutamide. His main example is the EMBARK trial, which studied enzalutamide’s efficacy in patients with high-risk biochemical recurrence. He reviews the key structure of the trial and compares the outcomes of the combination therapy, androgen deprivation therapy alone, and enzalutamide monotherapy groups, including metastasis-free survival benefits, PSA-related results, and differences in discontinuation or suspension of treatment due to side effects. Acknowledging the importance of monitoring and individualizing treatment duration in real practice, he addresses safety considerations and common adverse effects.
Dr. Javier-DesLoges emphasizes that risk stratification is essential. Local control may benefit selected patients, while enzalutamide can provide disease control but may have notable side effects. Decision-making requires thoughtful patient selection and counseling.
About the 32nd Annual Perspectives in Urology: Point Counterpoint conference: Presented by Program Chair and Grand Rounds in Urology Editor-in-Chief E. David Crawford, MD, this conference brought together leading experts in urology, medical oncology, and radiation oncology to discuss and debate the latest topics in genitourinary cancers, primarily prostate cancer and bladder cancer. This interactive conference offered topical lectures, pro/con debates, interesting case presentations, interactive panel discussions, and interactive audience and faculty networking.
ABOUT THE AUTHOR
Juan Javier-DesLoges, MD, MS, FACS, is an Assistant Professor of Urology and a Urologic Oncologist at the University of California, San Diego. Dr. Javier-DesLoges specializes in robot-assisted minimally invasive surgery as well as transperineal procedures, including SpaceOAR Hydrogel (a rectal spacer), prostate biopsy, and cryoablation. His clinical focus is on the management of prostate, bladder, kidney, and ureteral cancer.
