Metastatic prostate cancer management: 20 years of progress

Abstract

Since 1940, patients with metastatic prostate cancer were given androgen deprivation therapy alone. In 2013, the addition of docetaxel improved progression-free survival and overall survival in patients with metastatic hormone-sensitive prostate cancer. 1 Gravis G Fizazi K Joly F et al. Androgen-deprivation therapy alone or with docetaxel in non-castrate metastatic prostate cancer (GETUG-AFU 15): a randomised, open-label, phase 3 trial. Lancet Oncol. 2013; 14: 149-158 Summary Full Text Full Text PDF PubMed Scopus (528) Google Scholar , 2 Sweeney CJ Chen YH Carducci M et al. Chemohormonal therapy in metastatic hormone-sensitive prostate cancer. N Engl J Med. 2015; 373: 737-746 Crossref PubMed Scopus (1831) Google Scholar After 2013, the combination of abiraterone acetate plus prednisolone with androgen deprivation therapy increased overall survival, as did the addition of other androgen receptor signalling inhibitors (such as enzalutamide or apalutamide) to standard androgen deprivation therapy. 3 James ND de Bono JS Spears MR et al. Abiraterone for prostate cancer not previously treated with hormone therapy. N Engl J Med. 2017; 377: 338-351 Crossref PubMed Scopus (1091) Google Scholar , 4 Davis ID Martin AJ Stockler MR et al. Enzalutamide with standard first-line therapy in metastatic prostate cancer. N Engl J Med. 2019; 381: 121-131 Crossref PubMed Scopus (734) Google Scholar , 5 Chi KN Chowdhury S Bjartell A et al. Apalutamide in patients with metastatic castration-sensitive prostate cancer: final survival analysis of the randomized, double-blind, phase III TITAN study. J Clin Oncol. 2021; 39: 2294-2303 Crossref PubMed Scopus (124) Google Scholar In 2022, the triple combination of androgen deprivation therapy, docetaxel, and abiraterone or darolutamide showed improved overall survival compared with androgen deprivation therapy plus docetaxel. 6 Fizazi K Foulon S Carles J et al. Abiraterone plus prednisone added to androgen deprivation therapy and docetaxel in de novo metastatic castration-sensitive prostate cancer (PEACE-1): a multicentre, open-label, randomised, phase 3 study with a 2 × 2 factorial design. Lancet. 2022; 399: 1695-1707 Summary Full Text Full Text PDF PubMed Scopus (112) Google Scholar , 7 Smith MR Hussain M Saad F et al. Darolutamide and survival in metastatic, hormone-sensitive prostate cancer. N Engl J Med. 2022; 386: 1132-1142 Crossref PubMed Scopus (153) Google Scholar Abiraterone acetate plus prednisolone with or without enzalutamide for patients with metastatic prostate cancer starting androgen deprivation therapy: final results from two randomised phase 3 trials of the STAMPEDE platform protocolEnzalutamide and abiraterone should not be combined for patients with prostate cancer starting long-term androgen deprivation therapy. Clinically important improvements in survival from addition of abiraterone to androgen deprivation therapy are maintained for longer than 7 years. Full-Text PDF Open Access