Active surveillance (AS) is a widely recognized and utilized option by which
prostate cancer patients with less aggressive
tumors on diagnosis defer immediate traditional conventional
therapy (surgery, radiation) and undergo close monitoring by a physician for any clinical or pathologic changes. The juxtaposition of low- to intermediate-risk elderly patients between effective and conventional treatment with associated risks and monitoring without the opportunity for relief of anxiety and other psychological problems can be significant. Minimal and safe treatment over 6 months with the hope of eliminating the existing disease is of significant interest to
prostate cancer patients. Unfortunately, dietary supplements have failed to improve and have sometimes even contributed to
disease progression. In addition, the use of multiple medications is not always appropriate or safe. In this case study, we administered low doses of
enzalutamide (80 mg/day-120 mg/day) in an AS patient during a 6 month period. Results showed a significant reduction in
tumor size, as evidenced by magnetic resonance imaging and color Doppler, as well as a an undetectable level of
prostate specific antigen during, and immediately following treatment. The use of an oral second-generation
androgen-receptor signaling inhibitor was shown to be of benefit to patients unwilling to pursue AS and conventional treatment. Administration of
enzalutamide did not reduce
testosterone levels, but helped maintain good quality of life, was more cost effective at low doses, and was previously shown to be heart healthy and efficacious during early stages of
castration-resistant
prostate cancer. Although we do not advocate
enzalutamide as a treatment approach in these situations, we believe that a clinical trial to evaluate short-term low-dose treatment using
enzalutamide is warranted.