How do you decide between abiraterone or docetaxel for first line treatment of newly diagnosed metastatic prostate cancer?

Abiraterone (LATITUDE and STAMPEDE trials) and docetaxel (CHAARTED and STAMPEDE trials) both have level 1 evidence supporting their use in men with metastatic hormone-sensitive prostate cancer. However, a pre-planned subset analysis from the CHAARTED study demonstrated that docetaxel only appeared to benefit men with high volume metastatic disease (visceral metastases and/or ≥4 bone metastases with at least one outside of the vertebral column and pelvis) -- a finding that persisted with longterm...

I agree and would only point out that a recent analysis of docetaxel/ADT outcomes in STAMPEDE by disease volume, have identified improved overall survival regardless of disease volume. In this 2019 ESMO late-breaking abstract, which is still not published to my knowledge, the HR for OS in high volume men was 0.81 (95% CI 0.64-1.02), with a 10% improvement in 5-year survival from 24-->34%. In the low volume patients, the HR for OS was 0.76 (95% CI 0.54-1.07), with a 15% improvement in 5-year surv...