UpToDate®

UpToDate® and Oncology Times are collaborating to present select newly released UpToDate Oncology content synopses, such as the examples below. UpToDate is the premier evidence-based, clinical support resource used by oncology professionals and healthcare practitioners worldwide to make informed clinical decisions at the point of care. Please note that the examples below are accurate as of the month/year indicated next to each topic excerpt. To ensure you are accessing the most current clinical information, subscribe to UpToDate. For a limited time, you can receive an additional 30 days added to an annual or longer personal subscription term when you visit go.uptodate.com/ot30 and enter promo code OT30. This offer is valid through February 28, 2026. Postmastectomy radiation in breast cancer (November 2025) Trials are evaluating radiation after mastectomy in patients with breast cancer. In a randomized trial in 1,607 patients with intermediate-risk breast cancer, chest wall radiation did not improve overall survival or disease-free survival and only modestly improved chest wall recurrences.1 However, by design, the radiation fields in this trial did not include the regional nodes, which are typically included in postmastectomy radiation fields. As such, these results do not alter our practice of offering postmastectomy radiation, including the regional nodes, to those with involved lymph nodes. Reduction in prostate cancer deaths with PSA screening (November 2025) The benefits and harms of prostate cancer screening in average-risk males are closely matched. The most recent report from a large, well-designed randomized trial of prostate cancer screening with prostate-specific antigen (PSA) demonstrated a small, but persistent, reduction in prostate cancer deaths that began at 9 years of follow-up.2 At 23-year follow-up, the absolute risk reduction with PSA screening was 0.22%, which translates into a number needed to screen of 456 to prevent one prostate cancer death. Although these results confirm a small decrease in prostate cancer deaths with PSA screening, individualized decision-making is important given the potential harms of overdiagnosis and overtreatment. Enzalutamide and ADT in high-risk biochemical recurrence of prostate cancer (November 2025) For patients with a high-risk biochemical recurrence of prostate cancer, a randomized trial previously showed an improvement in metastasis-free survival with the addition of enzalutamide to androgen deprivation therapy (ADT). Now, with longer follow-up, the combination of enzalutamide and ADT also shows an improvement in the 8-year overall survival when compared with ADT alone (79% vs. 70%).3 Treatment-related adverse events were more common in the combination group (87% vs. 81%). Based on these data, we continue to suggest enzalutamide and ADT for such patients, but consider either enzalutamide or ADT alone as acceptable alternatives for those who wish to avoid the toxicity of combination therapy. ctDNA-guided use of adjuvant immunotherapy in high-risk muscle-invasive bladder cancer (November 2025) For patients with muscle-invasive bladder cancer (MIBC) who undergo cystectomy (with or without prior neoadjuvant therapy) and are at high risk for disease recurrence, studies are evaluating the use of circulating tumor deoxyribonucleic acid (ctDNA) to select adjuvant immunotherapy. In a randomized trial that included 250 such patients with a positive ctDNA test during 1 year of postoperative surveillance, 1 year of adjuvant atezolizumab improved both disease-free (median 10 vs. 5 months) and overall (median 33 vs. 21 months) survival relative to placebo, with good tolerability.4 For patients with high-risk MIBC following cystectomy, we await regulatory approval and/or incorporation into clinical guidelines prior to the routine use of ctDNA-guided selection of adjuvant immunotherapy. Adjuvant pembrolizumab in patients with resected Merkel cell carcinoma (November 2025) Studies are investigating the use of adjuvant immunotherapy in patients with resected Merkel cell carcinoma (MCC). In a randomized trial presented in abstract form, among 293 patients with resected MCC, 2-year recurrence-free survival (RFS) rates with vs. without pembrolizumab were 73% vs. 66%, but the difference was not statistically significant.5 Distant metastases-free survival was improved with pembrolizumab (hazard ratio [HR] 0.58), but grade ≥3 toxicity was higher (31% vs. 4%). We await overall survival data prior to use of adjuvant immunotherapy for most patients with resected MCC, although we offer it to select patients with high-risk resected MCC after shared decision making. These abstracts can be found at www.uptodate.com/contents/whats-new-in-oncology. Disclaimer: This content is provided for reference purposes only and represents a portion of an UpToDate topic. This content is only accurate as of the date it was published. You may not rely on the above content, or any information cited here as being applicable to specific patient circumstances. All topics are continuously updated as new evidence becomes available and subject to our peer-review process. To ensure you are accessing the most current clinical information, subscribe to UpToDate today at go.uptodate.com/ot30 or sign into your existing UpToDate account if you are a current subscriber.