When would you recommend abiraterone concurrently with RT for high-risk prostate cancer?

The trial got published in NEJM. It confirms survival advantage and skeletal mets advantage with abiraterone for metastatic disease similar to the Latitude study. This will certainly be an option for metastatic disease at presentation (along with docetaxel until comparative studies comparing docetaxel and abiraterone are published). The HR for overall survival for non-metastatic diseases crosses one and there appears to be no difference in skeletal mets in this subgroup. There is improvement in ...

The authors argue (including Dr. James in his presentation): that lack of heterogenity between M0 and M1 patients means the magnitude of impact on long-term outcomes would be similar for non-metastatic disease (even though few deaths in M0 patients thus far). These data, while pobably not enough to change practice so far, are intriguing! Perhaps a new way ahead w/RT to improve outcomes in patients with bad/bulky/N+ disease, etc...

Importantly for M+ patients, treatment continued until PSA/clinic...

Approximately 40% of patients in both arms received radiotherapy. Of note, while ADT was given for at least 2 years, radiotherapy was mandatory for patients with node-negative, nonmetastatic disease at 6 to 9 months after randomization and optional for patients with node-positive, nonmetastatic disease. Details of the radiotherapy cohort are not detailed so it is difficult to compare these results to prospective trials that address patients receiving radiation and XRT with the intent of cure. Mo...