Enzalutamide With ADT: — What Each Treatment Contributes

ADT alone controls prostate cancer well for many patients for a period of time. But residual androgens and changes in the cancer cells themselves can allow growth to resume. Enzalutamide is added to block the androgen receptor directly, aiming to delay that point. NCCN and ESMO guidelines recommend the combination for certain stages of prostate cancer because evidence shows it improves disease control in those settings compared with ADT alone.

The duration depends on your specific situation — your cancer's stage, how it responds and how you tolerate the side effects. Some people continue for several years if the combination is working and manageable. Your oncologist will review your PSA and imaging at regular intervals. The plan may change if your cancer progresses, if a side effect becomes difficult to live with, or if new evidence changes the recommended approach.

A rising PSA while on both treatments can indicate that the cancer is no longer fully controlled by the current regimen. This does not always mean the treatment has stopped working entirely, or that a change is needed immediately. Your oncologist will consider the rate of rise, your scans and any symptoms before deciding on next steps. Report a PSA rise to your team rather than waiting to see if it settles.

Yes, and this is important. Enzalutamide affects liver enzymes that process many other drugs, which can raise or lower their levels in your body. This includes some heart medicines, blood thinners, antifungals and certain supplements. Give your oncology team a complete list of everything you take — including over-the-counter medicines, vitamins and herbal preparations — before starting enzalutamide, and whenever you add something new.

Please tell your oncology team before adding anything. Some herbal preparations can affect the way enzalutamide is processed by the body, either raising or lowering its levels — and both directions can be a problem. Your team needs this information to keep the treatment working safely. They are not there to judge your choices; knowing what you are taking is a clinical necessity, not a preference.

Yes. Other androgen receptor inhibitors — apalutamide and darolutamide — work by a similar mechanism and are approved for comparable settings. Abiraterone acetate, which reduces androgen production from the adrenal glands and within the tumour, is another established option. Which treatment is right for you depends on your cancer's stage, other health conditions, any medicines you are already taking and what is available at your centre. Your oncologist will explain which applies to your situation.