NEJM August 2026 Perioperative Apalutamide in High-Risk Localized Prostate Cancer

This clinical trial investigated whether adding the drug apalutamide to standard hormone therapy could improve outcomes for patients undergoing surgery for high-risk prostate cancer. By administering this combination both before and after a radical prostatectomy, researchers found that patients were significantly more likely to achieve a pathological complete response or have minimal remaining disease compared to those receiving a placebo. Most importantly, the integrated treatment approach extended metastasis-free survival, meaning patients lived longer without the cancer spreading to other parts of the body. While the treatment led to superior oncologic outcomes, it also resulted in a higher frequency of side effects, such as skin rashes, highlighting a trade-off between increased efficacy and treatment toxicity.