Practice-Changing Takeaways and Open Questions From PROTEUS

Dr. Kalantri emphasizes that the overall treatment paradigm isn't changing, but clinicians now have to weigh adding ADT plus apalutamide for a subset of high-risk surgical patients. He outlines open questions: since ADT alongside surgery alone isn't standard, a pending substudy comparing surgery alone with surgery plus ADT plus apalutamide will clarify the added value; the trial's roughly one-year ADT duration is shorter than sometimes used with radiation; and it's unclear whether adjuvant therapy is warranted after a patient achieves pathologic complete response. He closes by framing PROTEUS as an important new option requiring attention to these nuances.