8 What's new in prostate cancer treatment and how do we improve disease free survival in high-risk prostate cancer: Report back from the plenary session at ASCO 2026 ASCO 2026: Perioperative (Neoadjuvant and Adjuvant) Apalutamide + ADT Versus Placebo + ADT with Radical Prostatectomy in High-Risk Localized or Locally Advanced Prostate Cancer: Final Analysis of the PROTEUS Phase 3 Study. High-Risk Relapse Rates: While overall post-prostatectomy BCR (Biochemical recurrence) across all risk groups is about 20% to 40%, patients with high-risk features have much higher relapse rates. Specialized cohort studies on high-risk localized disease report biochemical recurrence-free survival rates of roughly 65% to 70% at 5–10 years (meaning a 30% to 35%+ relapse rate). Although there is improvement in surgical techniques including robotic assistance, which have ensured improvement in mortality and morbidity, prostate cancer is a systemic illness, and the disease is often microscopically more advanced than predicted by PSA levels, MRI, and PSMA-PET ndings. ASCO is the largest oncology conference in the world. Groundbreaking and practice changing results are kept for the plenary session. This year ASCO did not disappoint, and the nal results of the phase 3 PROTEUS trial were presented. Many trials have failed to establish a benet with perioperative systemic therapy in tandem with radical prostatectomy (RP) in high-risk localized prostate cancer, this phase 3 trial delivered a breakthrough. However, there are positive phase 2 trials such as the ARNEO study, which recruited around the same time as PROTEUS: Conducted from 2019 to 2021 and presented at the European Association of Urology Annual Congress in 2022. It included a propensity score analysis emphasising the difference in relapse rate and the decreased necessity of future therapies. The Apa-RP study (NCT04523207) produced similar results, published in 2024. There are several other phase II trials alluding to the improved relapse free survival, inclusive of patients' quality of life and sexual function questionnaires. The trials were small but produced promising results. Dr Daleen Geldenhuys MBBCh (WITS), FCP (SA), Certificate Medical Oncology (SA) Dr Daleen Geldenhuys is a community oncologist working at Life Flora Clinic and Johannesburg Surgical Hospital. Both hospitals have multidisciplinary meetings with various specialities represented.
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