(Do not) ENACT!!!!

Wow did this paper cause a fuss this week!! The ENACT trial was published online in JAMA Oncology last weekend and provoked a huge outcry on social media. Many people were  genuinely shocked at the study design, the conclusions, even the title of the study.
We've linked to the paper below, but in summary, this prospective multi centre study enrolled patients with with low-risk or favourable intermediate-risk prostate cancer, entirely suitable for active surveillance (ie no treatment/no side-effects), and randomised half of them to receive enzalutamide. Yes enzulautmide,  a super powerful AR pathway inhibitor that works very well in men with advanced prostate cancer. But with plenty of side-effects.
So we decided to invite study co-author, active surveillance advocate and friend of teh podcast, Dr Matt Cooperberg, to come on and help us understand the rationale. We also welcomed Dr Keith Kowalczyk, Georgetown Medical Centre, Washington DC, to help us figure it out.
What do you think? Comments welcome on our Youtube channel

Links:
ENACT paper