From perioperative treatment in high-risk localized disease, to long-term survival in metastatic prostate cancer, here are five key abstracts presented at ESMO 2026 that offer new evidence to consider when evaluating treatment strategies
“ESMO 2026 moved intensification firmly into the curative setting. DASL-HiCaP showed that adding darolutamide to ADT and radiotherapy significantly improves metastasis-free survival in very high-risk disease. The PROTEUS substudy confirmed the benefit of perioperative apalutamide plus ADT over surgery alone. Both trials are practice-informing, but overall survival is not yet mature. In metastatic hormone-sensitive disease, the updated CAPItello-281 data support a biomarker-driven approach with capivasertib for PTEN-deficient tumours. For urologists, this means multidisciplinary discussion of systemic therapy becomes mandatory before any local treatment of high-risk prostate cancer.” – Prof Axel Stuart Merseburger (University Hospital Schleswig-Holstein, Germany)
The European Society for Medical Oncology (ESMO) Congress 2026, presented new findings across the prostate cancer treatment landscape, from intensifying treatment before and after surgery to improving outcomes in metastatic disease. This round-up examines five selected studies: DASL-HiCaP, the PROTEUS substudy, CAPItello-281, PEACE-1 and CCTG PR21. Together, the findings address treatment intensification in high-risk localized disease, targeted treatment for PTEN-deficient tumors, the durability of survival benefits with abiraterone and patient-reported quality of life with different treatments for metastatic castration-resistant prostate cancer (mCRPC).
Localized prostate cancer
DASL-HiCaP: Darolutamide plus ADT and radiotherapy in very high-risk localized prostate cancer
Abstract: LBA4 | ClinicalTrials.gov: NCT04136353 | Phase: III
Presented during the Presidential Symposium, the DASL-HiCaP trial evaluated darolutamide plus androgen deprivation therapy (ADT) and radiotherapy (RT) in 1,106 patients with very high-risk localized or biochemically persistent/recurrent prostate cancer. At a median follow-up of 3.8 years, 4-year metastasis-free survival based on conventional imaging (MFS-CI) was 95% with darolutamide versus 88% with placebo (HR, 0.42; 95% CI, 0.27–0.66; p=0.0001). Four-year PSA-progression-free survival was 91% versus 83% (HR, 0.47; 95% CI, 0.33–0.67). Grade ≥3 adverse events occurred in 43% versus 36% of patients.
Key clinical takeaway: Adding darolutamide to ADT and locoregional RT significantly improved MFS-CI. Follow-up is ongoing to confirm the surrogacy of MFS-CI for overall survival (OS).
PROTEUS: Perioperative apalutamide plus ADT compared with surgery alone
Abstract: LBA53 | ClinicalTrials.gov: NCT03767244 | Phase: III substudy
This PROTEUS substudy compared perioperative apalutamide (APA) plus ADT with radical prostatectomy (RP) and pelvic lymph node dissection (PLND) alone in 408 patients with high-risk localized or locally advanced prostate cancer. At a median follow-up of 37.8 months, median event-free survival (EFS) was not reached with APA plus ADT versus 19.1 months with RP alone (HR, 0.38; 95% CI, 0.26–0.55; p<0.0001). Metastasis-free survival also favored APA plus ADT (HR, 0.49; 95% CI, 0.26–0.90). At 3 years, 35% versus 68% of patients had received subsequent treatment. Grade 3/4 adverse events occurred in 30.7% versus 21.7%.
Key clinical takeaway: Perioperative APA plus ADT significantly improved EFS and metastasis-free survival and reduced subsequent treatment compared with RP alone in this substudy.
Metastatic prostate cancer
CAPItello-281: Updated survival results with capivasertib plus abiraterone in PTEN-deficient mHSPC
Abstract: LBA56 | ClinicalTrials.gov: NCT04493853 | Phase: III
CAPItello-281 evaluated capivasertib plus abiraterone versus placebo plus abiraterone in 1,012 patients with PTEN-deficient de novo metastatic hormone-sensitive prostate cancer (mHSPC). At the March 9, 2026 data cutoff, median OS was 57.4 versus 46.5 months (HR, 0.82; 95% CI, 0.68–0.99; p=0.044). The updated descriptive OS analysis did not meet statistical significance. Median radiographic progression-free survival (rPFS) was 35.5 versus 26.0 months (HR, 0.83; 95% CI, 0.70–0.99; nominal p=0.033). The updated rPFS analysis was descriptive and not formally tested. The safety profile remained consistent with the primary analysis.
Key clinical takeaway: Updated results favored capivasertib plus abiraterone for OS and rPFS, although the descriptive OS analysis did not meet statistical significance.
PEACE-1: Long-term OS with abiraterone in de novo metastatic castration-sensitive prostate cancer
Abstract: 2215O | ClinicalTrials.gov: NCT01957436 | Phase: III
PEACE-1 evaluated abiraterone acetate plus prednisone and/or prostate radiotherapy alongside standard-of-care treatment in 1,173 patients with de novo metastatic castration-sensitive prostate cancer (mCSPC). After a median follow-up of 7.7 years, adding abiraterone significantly improved OS (HR, 0.75; 95% CI, 0.65–0.87; p=0.0001). Among 710 patients receiving ADT plus docetaxel, median OS was 6.2 years with additional abiraterone versus 4.4 years with ADT plus docetaxel alone (HR, 0.68; 95% CI, 0.56–0.82). Eight-year OS rates were 40.3% versus 27.1%, respectively.
Key clinical takeaway: Long-term follow-up supports the durability of the OS benefit associated with adding abiraterone to standard treatment, including ADT plus docetaxel.
CCTG PR21: Patient-reported quality of life with docetaxel versus ¹⁷⁷Lu-PSMA-617 in mCRPC
Abstract: 2221RO | ClinicalTrials.gov: NCT04663997 | Phase: II
CCTG PR21 compared docetaxel (Doc) with lutetium-177–PSMA-617 (LuP) in patients with metastatic castration-resistant prostate cancer (mCRPC) previously treated with an androgen receptor pathway inhibitor. Of 199 randomized patients, 189 started treatment. Quality-of-life scores favored LuP: mean change in the Functional Assessment of Cancer Therapy–Prostate Trial Outcome Index at week 30 was −7.1 with Doc versus +2.8 with LuP (p<0.001). The proportion of patients reporting high treatment-related bother was 40.7% with Doc versus 15.4% with LuP. The trial found no significant difference in its primary endpoint of radiographic progression-free survival.
Key clinical takeaway: Patient-reported outcomes favored LuP over docetaxel, providing additional information for treatment discussions in eligible patients, although the primary efficacy endpoint did not differ significantly.
This content has been developed independently by Touch Medical Media for touchONCOLOGY. It is not affiliated with the European Society for Medical Oncology (ESMO). Views expressed are the speaker’s own and do not necessarily reflect the views of Touch Medical Media. This article was created by the editorial team utilizing AI as an editorial tool (Claude.AI and ChatGPT 5.5). The content was developed and edited by human editors. No funding was received in the publication of this article.
Disclosure: Prof Axel S Merseburger is a co-author of the PROTEUS substudy (LBA53).
Cite: ESMO 2026 prostate cancer round-up: What do the latest data show? touchONCOLOGY. 28th October 2026.
Editor: Sophie Nickelson
