Darolutamide

99% of men on standard therapy reached a PSA of 0.5 or lower, against 91% on darolutamide.

That's a gap of about eight points, but the upper end of its confidence interval reached 14.4, past the nine-point margin, so the trial couldn't rule out a larger loss, and non-inferiority wasn't established.

Darolutamide's possible trade-off was erectile function.

Three months after treatment, 72% on darolutamide had good function against 44% on standard therapy.

But that endpoint was only to be tested if PSA suppression passed, so it's exploratory.

Of its 999 men, 345 got radiation with Relugolix, and at six months, 95 of the 100 who could be evaluated had castrate testosterone levels.

Neither substitute displaced standard hormone therapy at ASTRO.

Darolutamide couldn't show non-inferiority on PSA suppression, and Relugolix is still hormone therapy, delivered as a daily pill, with exploratory data on faster recovery.

Watch closely for fluid retention, heart failure decompensation.

Darolutamide generally has a less complex interaction profile, but suitability depends on cancer indication and complete medication list.

For serious toxicity, intensify management and reassess the dose or regimen with oncology team rather than making isolated medication changes.

So multidisciplinary management is optimal.