Given enzalutamide’s unique and multi-targeted mechanism of action, its once a day oral administration, avoidance of accompanying requirement of a steroid, and its established safety and efficacy data, it appears to be a very promising therapy. Future studies should investigate both combination strategies with other approved prostate cancer drugs, as well as the potential role of enzalutamide in earlier stages of both CRPC and androgen-sensitive prostate cancer.

In May 2011, the New England Journal of Medicine reported on 695 men from Sweden, Finland, and Iceland, average age 65, who were randomly allocated to either immediate surgery or delayed hormone therapy (DHT) between 1989 and 1999.  The median PSA for the 695 men was 13. Eighty percent of the men had palpable disease found during their digital rectal exam. In the men treated with DHT, hormone therapy was initiated if and when bone metastasis occurred. Bone scans were performed every other year.