Androgen Receptor Directed Therapy on Cognitive Function in Patients Treated With Darolutamide or Enzalutamide

The goal of the trial is to assess cognitive and quality of life outcomes over the

48-week primary data collection period of the trial. This is a prospective, randomized,

open-label phase II study comparing cognitive outcomes between men with Advanced prostate

cancer: metastatic and non-metastatic castration resistant prostate cancer (CRPC) or

metastatic hormone sensitive prostate cancer (HSPC).

The primary endpoint will be the percent change in the maximally changed cognitive domain

by 24 weeks in each study arm. Patients will be stratified by age (<65, 65-80, > 80).

Patients will be allowed to cross over from either treatment to the opposite treatment

arm at 12 and 24 weeks if they meet any of the cross-over criteria as described in the

protocol.

Cognitive assessments will be performed using Cambridge Neuropsychological Test Automated

Battery (CANTAB), an internationally recognized software for assessing cognitive function

and impairment. Tests available in the CANTAB battery include tests of learning and

executive function; working memory; visual, verbal and episodic memory; and attention,

information and processing time. The maximally changed cognitive domain is defined as the

domain most changed from baseline in each individual.

Blood samples will be collected for exploratory genomic analyses (AR CAG repeat length,

PHS, exosome analysis).

Patients will have the option to opt into an additional separate MRI sub-study. A subset

of 40 patients (20 per arm) will undergo fMRI to measure percent signal change in the HP

PFC circuit at baseline, 24 and 48 weeks or/and cross-over/end of treatment visit (if

applicable).