In light of the recent results from STAMPEDE and LATITUDE, to which patients with newly diagnosed metastatic prostate cancer are you offering up-front abiraterone vs. up-front docetaxel?

Although I anticipate that the Stampede investigators will publish (an underpowered) comparison of their ADT plus docetaxel arm vs ADT plus abiraterone which may provide some insight, for the most part we will be in a data free zone re: this issue for some time. I suspect that clinicians will continue to utilize both options, likely abiraterone for patients less fit and perhaps for those with ECOG "low volume" disease. With the many studies of next generation AR agents being studied even earlier in the disease course, should these studies be positive, further shifts will likely occur even before we sort out the question above.

The high volume patients who were getting chemo will be offered abiraterone provided the cost of the drug will be covered. I will hold off on the low volume patients for now- the median rPFS for the low volume patients on ADT alone on the GETUG 15 was 21 months. I would also not treat M0 patients . The patients getting RT is tempting as there may be a possibility of a higher fraction acheiving a cure with ADT +abi vs ADT alone