ESMO Congress 2026

For high-risk and very high-risk localized prostate cancer, definitive treatment has long rested on radiotherapy plus ADT: EORTC 22683 established this standard, yet many patients remain uncured, making treatment intensification the main theme ^[1]. Among published phase III evidence, STAMPEDE showed that adding abiraterone to ADT + radiotherapy significantly improved failure-free survival and overall survival ^[1]; building on such data, ASCO and NCCN guidelines have been updated to recommend considering the addition of second-generation anti-androgens to ADT in high-risk, very high-risk nonmetastatic or node-positive patients receiving radiotherapy ^[4]. Mechanistically, ADT sensitizes prostate cancer to radiotherapy-induced cell death, and AR pathway upregulation is closely linked to radiotherapy resistance, providing rationale for stronger AR inhibition in the radiotherapy setting ^[2]. Overall, intensification combining radiotherapy with hormonal or drug therapy has shown trends toward reduced disease-specific mortality and improved overall survival, though more studies are needed to confirm its efficacy ^[3].

At ESMO 2026, DASL-HiCaP enters the presidential session as LBA4, scheduled for Sunday 25 October at 16:30, and is ranked first among the top 10 prostate cancer trials in the live post. The trial tests intensified AR-targeted therapy by adding darolutamide to ADT + radiotherapy in very high-risk localized disease (the post also mentions a post-prostatectomy population), with metastasis-free survival (MFS) as the primary endpoint. Importantly, the live post explicitly states that the magnitude of the result is still pending, so concrete numbers must await the formal presentation; the central question posed is whether the benefit will justify 96 weeks of added therapy and its toxicity.

Relative to existing knowledge, the significance of this readout lies in extending intensification evidence from abiraterone to darolutamide: prior phase III intensification evidence centered on abiraterone ^[1][4], and the background literature lists DASL-HiCaP alongside ENZARAD, ATLAS, and GETUG-P17 ALADDIN as ongoing studies of new androgen receptor pathway inhibitors combined with RT and ADT, aiming to refine treatment strategies for high-risk localized disease in the context of patient upstaging driven by advanced imaging ^[1]. If positive, it would provide direct evidence on which second-generation anti-androgen to add to ADT + radiotherapy in very high-risk patients, giving the guideline-level recommendation to 'consider adding' a more specific basis for drug selection.

Limitations: the live post discloses no specific MFS, overall survival, or safety figures; the effect size and confidence intervals remain to be confirmed. As the post itself cautions, not all trials are expected to report positive results, and whether darolutamide can match the magnitude of benefit seen with abiraterone in STAMPEDE must await formal data. Meanwhile, the trade-off around 96 weeks of therapy—toxicity and adherence—will directly determine its clinical uptake.