# PROSPER: enzalutamide in men with non-metastatic castration-resistant prostate cancer

Source: https://onco.cc/key-papers/paper-prosper-nejm-2018/  
OnCo record `paper-prosper-nejm-2018` (Key paper). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Enzalutamide delayed metastases by almost two years in men with rapidly rising PSA on hormone therapy and no visible spread, and longer follow-up showed it also lengthened survival.

## Summary

Phase 3 placebo-controlled trial of 1,401 men with non-metastatic castration-resistant prostate cancer and PSA doubling time of ten months or less randomised 2:1 to enzalutamide or placebo with continued androgen deprivation.

Median metastasis-free survival was 36.6 versus 14.7 months (hazard ratio 0.29), and the final analysis showed median overall survival of 67.0 versus 56.3 months (hazard ratio 0.73); fatigue, hypertension and falls were more common.

## Fields

- Kind: Key paper
- Last checked: 2026-09-17
- Journal: New England Journal of Medicine
- Year: 2018
- DOI: 10.1056/NEJMoa1800536
- Authors: Hussain M, Fizazi K, Saad F, et al.
- Findings: Median metastasis-free survival 36.6 vs 14.7 months; hazard ratio 0.29.; Median overall survival 67.0 vs 56.3 months; hazard ratio 0.73.
- What it means: Enzalutamide is one of three androgen receptor inhibitors standard for high-risk non-metastatic castration-resistant prostate cancer.
- Caveats: Fatigue and cognitive effects are more prominent than with darolutamide.; Conventional imaging defined non-metastatic status.

## Sources

- N Engl J Med 2018: https://doi.org/10.1056/NEJMoa1800536
- PubMed: https://pubmed.ncbi.nlm.nih.gov/29949494/

## Connected records

- cancers: [Non-metastatic castration-resistant prostate cancer](https://onco.cc/cancers/prostate-nmcrpc/)
- drugs: [Enzalutamide](https://onco.cc/drugs/enzalutamide/)
- trials: [PROSPER](https://onco.cc/trials/prosper/)
- journals: [New England Journal of Medicine](https://onco.cc/journals/nejm/)

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