First Line Treatment for Newly Diagnosed Metastatic Prostate Cancer

Initially being diagnosed with metastatic, or advanced prostate cancer is not great.  Metastatic prostate cancer is not curable and will be terminal if you don’t die from another cause.  

We now have a number of what we consider second-line treatments for prostate cancer, drugs like Zytiga, Xtandi and Taxotere (chemotherapy).  These drugs are approved for use after the prostate cancer has stopped responding to first line hormone therapy (ADT). 

We are beginning to recognize the value of the early use of these second line drugs along with first line ADT for men who are initially diagnosed with metastatic prostate cancer.  

A recent paper published in the Annals of Oncology byVale et al. addressed the question of which of these second-line drugs might be superior for men who are newly diagnosed with ADT sensitive, advanced metastatic prostate cancer (mHSPC), or men who were newly diagnosed with advanced prostate cancer and had not yet had any ADT.  

Vale performed a meta-analysis of data from 11 trials. After a review their results were based on six of these trials that included a total of 6,204 men.

The overall results of this meta-analysis suggest that ADT along with Zytiga and prednisone (as used in the LATITUDE and STAMPEDE trials) has the highest probability of being the most effective treatment both for overall survival (94 percent probability) and failure-free survival (100 probability probability). 

ADT + docetatxel was the second-best treatment of overall survival (OS) (35 percent probability).

Vale et al. conclude that:

  • their results support the first-line use of either ADT + abiraterone acetate + prednisone or ADT + docetaxel in men with mHSPC.
  • That ADT + abiraterone acetate + prednisone appears to be the most effective treatment of these two options.  

They did make a cautionary note that it is not clear to what extent and whether this is due to a true increased benefit with ADT + abiraterone acetate + prednisone or the variable design features of the individual trials.

If you do decide to go in this direction please remember and discuss with your doctor the issue that long-term use of drugs like prednisone have their own constellation of side effects. 

Joel T. Nowak, MA, MSW wrote this Post.  Joel is the CEO/Executive Director of Cancer ABCs.  He is a Cancer Thriver diagnosed with five primary cancers - Thyroid, Metastatic Prostate, Renal, Melanoma, and the rare cancer Appendiceal cancer.