High hopes.

Should abiraterone or enzalutamide be added to androgen deprivation therapy (ADT) and radiation for men with high risk and lymph node positive prostate cancer? This iteration of the STAMPEDE trial performed a two-way comparison of 1) ADT versus ADT + abiraterone and 2) ADT versus ADT + abiraterone + enzalutamide and was recently reported at ESMO. Systemic therapies were continued for 2 years (or until progression if no radiation was given). There were over 1900 men in total and they had either high risk localized disease (T3/4, PSA 40+, and/or GS 8+; 79%) and/or lymph node only metastatic disease (39%). At 6 years, the addition of abiraterone-based therapy improved metastasis-free survival from 69 → 82% and overall survival from 77 → 86%. | Attard, ESMO 2021