Prostate Cancer · Medical · Perioperative Therapy
PROTEUS
In high-risk localized or locally advanced prostate cancer undergoing prostatectomy, does perioperative apalutamide plus ADT improve metastasis-free survival?
Tumour site
Prostate Cancer
Discipline
Medical
Clinical setting
Perioperative Therapy
Evidence type
Comparative clinical evidence
Absolute Effect
PROTEUS randomized 2,109 men to perioperative ADT plus apalutamide or ADT plus placebo around radical prostatectomy. Five-year metastasis-free survival was 78.2% versus 73.5%, an absolute improvement of 4.7 percentage points (HR 0.80, 95% CI 0.67–0.96).
NNT / NNH: Calculated only when a defensible fixed-time absolute event difference is available. Hazard ratios alone are not converted into NNT.
Clinical interpretation
The reported metastasis-free-survival benefit with perioperative apalutamide plus ADT is new phase III evidence for high-risk localized/locally advanced prostate cancer; adoption depends on approval and guideline implementation.
Limitations
The result applies to trial-defined high-risk patients undergoing prostatectomy and should not be extrapolated to low-risk disease or assumed to replace established salvage pathways.