A real-world study from Spain has delivered compelling evidence that apalutamide for prostate cancer treatment is delivering on its clinical trial promises, offering new hope to thousands of men battling the disease. The research, conducted at Hospital Universitario Central de Asturias and published in September 2025, tracked 89 patients with metastatic hormone-sensitive prostate cancer who received apalutamide.

The investigators found that nearly two-thirds of patients achieved profound drops in their PSA levels within just three months of starting treatment, with 65% reaching ultra-low levels that signal exceptional disease control. Even more remarkably, by six months, 71% of patients had achieved PSA levels below 0.2 ng/ml, while an impressive 53% reached ultra-low PSA levels below 0.02 ng/ml – a threshold that emerging research suggests predicts exceptional long-term outcomes. These results closely mirror those seen in major clinical trials, validating that the treatment’s benefits translate effectively from controlled research settings into everyday clinical practice.

The study’s use of advanced PET-PSMA imaging technology provided unprecedented precision in monitoring disease progression, revealing that 94% of patients remained free of detectable cancer spread at 12 months when this scanning method was employed.

Perhaps equally important for patients facing this diagnosis, the Spanish research documented that quality of life remained stable throughout treatment, with cancer-related symptoms actually improving over time. The proportion of patients reporting significant pain dropped from 35% to 22% over six months, while standardized quality-of-life measurements showed no decline during the study period.

The findings gain additional weight when viewed alongside extensive international real-world data that has emerged over the past two years. The largest European study, involving 242 patients across multiple centers, demonstrated that 96% achieved significant PSA reductions within 12 months, with 82% achieving dramatic 90% PSA drops. Meanwhile, a major US comparative study involving nearly 4,000 patients showed a 23% mortality reduction with apalutamide translating to 85.4% survival at 24 months.

The Spanish study’s focus on ultra-low PSA achievement aligns with emerging clinical understanding that patients reaching these profound response levels experience significantly improved long-term outcomes.

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