Armstrong AJ, Szmulewitz RZ, Petrylak DP ARCHES: a randomized, phase III study of androgen deprivation therapy with enzalutamide or placebo in men with metastatic hormone-sensitive prostate cancer. J Clin Oncol. 2019; 37:(32)2974-2986

Armstrong AJ, Szmulewitz RZ, Petrylak DP LBA25-final overall survival (OS) analysis from ARCHES: a randomised phase III study of androgen deprivation therapy with enzalutamide or placebo in men with metastatic hormone sensitive prostate cancer. Annals of Oncology. 2021; 32:S1283-S1346

Astellas. Enzalutamide product monograph. 2019. (accessed 1 September 2021)

Banna GL, Urzia V, Benanti C Adherence to abiraterone or enzalutamide in elderly metastatic castration-resistant prostate cancer. Support Care Cancer. 2020; 28:(10)4687-4695

Chi KN, Agarwal N, Bjartell A Apalutamide for metastatic, castration-sensitive prostate cancer. N Engl J Med. 2019; 381:(1)13-24

Davis ID, Martin AJ, Stockler MR Enzalutamide with standard first-line therapy in metastatic prostate cancer. N Engl J Med. 2019; 381:(2)121-131

dela Rama Pratz C. Navigating treatment of metastatic castration-resistant prostate cancer: nursing perspectives. Clin J Oncol Nurs. 2015; 19:(6)723-732

European Medicine Agency. European Medicines Agency: science medicines health. 2022. (accessed 1 December 2022)

Food and Drug Administration. FDA approves enzalutamide for metastatic castration-sensitive prostate cancer. 2019. (accessed 31 January 2023)

Ferro M, Lucarelli G, Crocetto F First-line systemic therapy for metastatic castration-sensitive prostate cancer: an updated systematic review with novel findings. Crit Rev Oncol Hematol. 2021; 157

Graff JN, Baciarello G, Armstrong AJ Efficacy and safety of enzalutamide in patients 75 years or older with chemotherapy-naive metastatic castration-resistant prostate cancer: results from PREVAIL. Ann Oncol. 2016; 27:(2)286-294

Hahn AW, Higano CS, Taplin ME metastatic castration-sensitive prostate cancer: optimizing patient selection and treatment. Am Soc Clin Oncol Educ Book. 2018; 38:363-371

Hall ME, Huelster HL, Luckenbaugh AN Metastatic hormone-sensitive prostate cancer: current perspective on the evolving therapeutic landscape. Onco Targets Ther. 2020; 13:3571-3581

Hand Née Davies PR. Non-medical prescribing of systemic anticancer therapy in a multidisciplinary team oncology clinic. Br J Nurs. 2019; 28:(11)715-720

Hussain M, Tangen CM, Berry DL Intermittent versus continuous androgen deprivation in prostate cancer. N Engl J Med. 2013; 368:(14)1314-1325

Joint Formulary Committee. Enzalutamide. 2022. (accessed 31 January 2023)

Kessel A, Kohli M, Swami U. Current management of metastatic castration-sensitive prostate cancer. Cancer Treat Res Commun. 2021; 28

Khalaf DJ, Sunderland K, Eigl BJ Health-related quality of life for abiraterone plus prednisone versus enzalutamide in patients with metastatic castration-resistant prostate cancer: results from a phase II randomized trial. Eur Urol. 2019; 75:(6)940-947

Kinnaird W, Konteti VK, Mitra A, Davda R, Payne H. Sexual dysfunction in men with advanced prostate cancer. Trends in Urology & Men's Health. 2021; 12:(3)7-12

Laccetti AL, Morris MJ, Kantoff PW. A clinical evaluation of enzalutamide in metastatic castration-sensitive prostate cancer: guiding principles for treatment selection and perspectives on research. Onco Targets Ther. 2020; 13:13247-13263

Morgans AK, Shore N, Cope D Androgen receptor inhibitor treatments: Cardiovascular adverse events and comorbidity considerations in patients with non-metastatic prostate cancer. Urol Oncol. 2021; 39:(1)52-62

National Institute for Health and Care Excellence. Enzalutamide for treating hormone-sensitive metastatic prostate cancer. 2021. (accessed 31 January 2023)

Nelson AM, Gonzalez BD, Jim HS Characteristics and predictors of fatigue among men receiving androgen deprivation therapy for prostate cancer: a controlled comparison. Support Care Cancer. 2016; 24:(10)4159-4166

Nursing and Midwifery Council. The Code. Professional standards of and behaviour for nurses, midwives and nursing associates. 2018. (accessed 31 January 2023)

Olivier KM, Floyd R, Smith MR, Shore ND, Sutton J. New treatments for patients with non-metastatic castration-resistant prostate cancer: a nursing perspective. International Journal of Urological Nursing.

Patel NK, Finianos A, Whitaker KD, Aragon-Ching JB. Advanced prostate cancer – patient survival and potential impact of enzalutamide and other emerging therapies. Ther Clin Risk Manag. 2014; 10:651-664

Paterson C, Nabi G. Non-medical prescribing in prostate cancer care: a case study reflection. International Journal of Urological Nursing. 2016; 11:(2)106-117

Ryan C, Wefel JS, Morgans AK. A review of prostate cancer treatment impact on the CNS and cognitive function. Prostate Cancer Prostatic Dis. 2020; 23:(2)207-219

Sathianathen NJ, Alarid-Escudero F, Kuntz KM A cost-effectiveness analysis of systemic therapy for metastatic hormone-sensitive prostate cancer. Eur Urol Oncol. 2019; 2:(6)649-655

Sternberg CN, Fizazi K, Saad F Enzalutamide and survival in nonmetastatic, castration-resistant prostate cancer. N Engl J Med. 2020; 382:(23)2197-2206

Wang L, Paller CJ, Hong H, De Felice A, Alexander GC, Brawley O. Comparison of systemic treatments for metastatic castration-sensitive prostate cancer: a systematic review and network meta-analysis. JAMA Oncol. 2021; 7:(3)412-420

Weeks G, George J, Maclure K, Stewart D. Non-medical prescribing versus medical prescribing for acute and chronic disease management in primary and secondary care. Cochrane Database Syst Rev. 2016; 11:(11)

Zerillo JA, Goldenberg BA, Kotecha RR, Tewari AK, Jacobson JO, Krzyzanowska MK. Interventions to improve oral chemotherapy safety and quality: a systematic review. JAMA Oncol. 2018; 4:(1)105-117

Enzalutamide in the treatment of metastatic castrate-sensitive prostate cancer

01 February 2023
Volume 5 · Issue 2


The treatment landscape for metastatic castrate-sensitive prostate cancer has changed dramatically in the past decade because of the approval of chemotherapy and novel androgen therapies in combination with androgen deprivation therapy. The addition of these agents has resulted in overall benefits and progression-free survival for patients. The National Institute for Health and Care Excellence recently approved enzalutamide in the treatment of metastatic castrate-sensitive prostate cancer. Oncology nurse prescribers are central to the care of prostate cancer, providing holistic assessment and management of the disease and treatment side effects. A comprehensive understanding of the mechanism of action and specific side effects of androgen receptor inhibitors will enable an oncology nurse to provide timely interventions with a high standard of care.

Prostate cancer is the most common non-cutaneous malignancy in men with more than 57 000 cases diagnosed in the UK each year. It is the second leading cause of cancer deaths (Kessel et al, 2021; Kinnaird et al, 2021). The majority of patients present with localised disease confined to the prostate, where the 5-year survival rate is up to 99%. In contrast, when metastatic disease develops, the 5-year survival rate decreases to 30%. Prostate cancer cells depend on the androgen hormone testosterone to grow and survive. The mainstay of treatment for metastatic castrate-sensitive prostate cancer has been androgen deprivation therapy (ADT), which controls the disease by lowering androgen levels. ADT was originally discovered by Higgins and Hodges in 1940. It is achieved using either surgical bilateral orchidectomy or medical gonadotropin-releasing hormone agonists (GnRH). The use of continous, rather than intermittent, ADT is recommended as data show this leads to a higher overall survival rate (Hussain et al, 2013). In the majority of cases of metastatic castrate-sensitive prostate cancer, tumours stop responding to androgen deprivation after 2–3 years, becoming castrate-resistant (Dela Rama and Pratz, 2015).

Register now to continue reading

Thank you for visiting Journal of Prescribing Practice and reading some of our peer-reviewed resources for prescribing professionals. To read more, please register today. You’ll enjoy the following great benefits:

What's included

  • Limited access to our clinical or professional articles

  • New content and clinical newsletter updates each month