Highlights in Prostate Cancer from ESMO 2021

Findings from the STAMPEDE trial present a new standard of care in high-risk, localized non-metastatic prostate cancerPrior to ESMO 2021, 20% of localized prostate cancers were considered high risk at diagnosis, accounting for the majority of relapses and deaths.Androgen deprivation therapy (ADT) is recommended for 2-3 years in combination with local radiotherapy to the prostate and pelvis, which improves life expectancy.The addition of docetaxel has been shown to prolong the time to relapse but did not prolong the overall survival (OS) in this patient population.The practice-changing STAMPEDE trial is a multi-arm, multi-stage trial ongoing at over 100 hospitals in the UK and Switzerland where patients with either high risk, localized or locally advanced (M0) or metastatic disease (M1) were enrolled. 1The primary results showed that a consistent OS benefit was observed by the addition of abiraterone acetate and prednisolone (AAP).The STAMPEDE trial focused on high-risk localized or locally advanced prostate cancer patients who were given abiraterone in addition to ADT.Overall, 1,974 enrolled patients underwent conventional imaging and bone scan. 2 Patients were either N1, positive disease, non-metastatic high risk or N0 with ≥2 of the following characteristics: either clinical stage T3 or T4, prostate-specific antigen (PSA) level ≥40 ng/ml and a Gleason score of ≥8.A small proportion of patients were enrolled who relapsed after curative local treatment with radical prostatectomy or radiotherapy as well as a PSA score ≥40 ng/ml (rising) and a PSA doubling time <6 months.Patients with N1 disease constituted 39% of the population, 3% of whom had suffered a relapse.Patients were randomized 1:1 to either standard of care (ADT for three years plus radiotherapy), or standard of care (SOC) plus AAP for two years.At a median follow-up of 72 months, there was a significant improvement in 6-year metastasis-free survival, from 69-82%, with the addition of abiraterone to the standard of care ADT (HR: 0.53 [95% CI: 0.44-0.64];p=2.9 x 10 -11 ). 2 In addition, 6-year OS improved from 77-86% after 72-month follow-up (HR: 0.60 [95% CI: 0.48-0.73];p=9.3 x 10 -7 ).However, the