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Improving the outcomes of medical or surgical castration for men with prostate cancer has been an elusive goal since the approach was first reported in the 1940s.1 However, this situation changed at the annual American Society of Clinical Oncology meeting in 2014, when results reported from the ChemoHormonal Therapy Versus Androgen Ablation Randomized Trial for Extensive Disease (CHAARTED) showed that addition of six cycles of docetaxel to standard of care (testosterone lowering hormone therapy) prolonged the survival of men with metastatic disease at the time of diagnosis relative to treatment with hormones alone.2, 3 The result contrasted with a trial of similar design, GETUG-AFU 15, that did not show a survival benefit.4

In The Lancet, Nicholas James and colleagues5 report on the Systemic Therapy in Advancing or Metastatic Prostate Cancer: Evaluation of Drug Efficacy (STAMPEDE) study, a multinational trial of unparalleled scope and size designed to establish new standards of care for prostate cancer patients starting first-line hormone therapy. The report includes 2962 men with high-risk localised, node-only disease, and metastatic disease that was newly diagnosed or that relapsed after local therapy, who were randomised to one of four treatment groups: standard of care (SOC) alone, standard of care plus zoledronic acid (SOC + ZA), standard of care plus docetaxel (SOC + Doc), or standard of care plus zoledronic acid plus docetaxel (SOC + ZA + Doc).

Overall, relative to SOC alone, SOC + Doc reduced mortality by 22% (hazard ratio 0·78 [95% CI 0·66–0·93]), prolonged median overall survival by 10 months (81 months vs 71 months), and increased absolute 5-year survival by 8% (63% vs 55%). For the subset of patients with metastatic disease, the relative reduction in mortality was 24% (hazard ratio 0·76 [95% CI 0·62–0·92]), median survival increased by 15 months (60 months vs 45 months), and absolute 5-year survival increased by 11% (50% vs 39%)

full text @: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2815%2901235-0/fulltext

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