In light of CHAARTED and STAMPEDE, should all men with newly-diagnosed, treatment-naive metastatic prostate cancer be treated with chemohormonal therapy?

This is an evolving answer but presently I do offer 6 cycles of docetaxel to men with M1 (not N1) CSPC who are initiating or who have recently initiated ADT. This would include men who present with M1 disease but also men with rapidly recurrent mCSPC who are hormone naive. There appears to be a greater or more noticeable survival benefit in CHAARTED in men with higher volume extensive metastases but the hazard ratio was similar for lower volume men. There was a survival benefit for all comers in the much larger STAMPEDE trial. So presently NCCN guidelines for 2016 permit chemo hormonal therapy for all M1 CSPC patients, but this would be limited to chemotherapy fit individuals after an informed risk-benefit discussion.