Drug therapy of hormone-sensitive metastatic prostate cancer. Consensus paper of the AKO/AUO

The standard treatment of patients with metastatic, hormone-sensitive prostate cancer (mCSPC) currently consists of medical or surgical castration. The addition of a cytotoxic chemotherapy was unable to provide a survival benefit over castration alone in several clinical trials using different chemotherapy regimens. Even a preliminary clinical trial using a docetaxel-based chemohormonal combination did not show a survival benefit. In contrast, two more recently published clinical trials (CHAARTED and STAMPEDE) using docetaxel in combination with castration provided evidence for a substantial improvement in overall survival. The survival benefit was 14 and 22 months in the two trials. In addition, the CHAARTED trial showed that patients with high volume disease may benefit most from chemohormonal treatment. According to the current available evidence, the new standard of treatment for patients therefore consists of castration in combination with docetaxel-based chemotherapy and should be offered to all patients who are fit to receive chemotherapy.