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About · curated by Nick Boehling, MD · @nb2276

    2026-07-15

    digest generated 2026-07-16

    STAMPEDE: adding 2yr abiraterone to ADT+RT in high-risk M0 prostate cuts MFS (HR 0.53) and OS (HR 0.60); enzalutamide adds nothing.
    TL;DR
    Prostate carried the day. A pooled STAMPEDE analysis moves 2yr abiraterone onto the ADT+RT backbone for high-risk M0 disease (6-yr MFS 82% vs 69%). RT was mandated for N0, so this is the curative population radoncs already treat; adding enzalutamide gave no incremental MFS.

    Prostate

    Abiraterone intensification extends from metastatic HSPC into the high-risk M0 curative setting on an RT backbone.

    STAMPEDE: abiraterone + prednisolone ± enzalutamide, high-risk non-metastatic prostate cancer NCT00268476

    ForHigh-risk M0 prostate: N+ or N0 with ≥2 of T3/4, Gleason 8-10, PSA≥40

    TL;DRMFS HR 0.53 and OS HR 0.60 adding 2yr abiraterone to ADT+RT in high-risk M0 prostate.

    Why it mattersRadiation oncology

    85% of pts were planned for RT (mandated for N0, 74Gy/37fx to prostate+SV), so the abiraterone benefit lands on the RT+ADT patient you treat. Adding enzalutamide to abiraterone added nothing (interaction HR 1.02, p=0.91): intensify the backbone with abiraterone alone, not a second ARSI.

    vs leading data
    • Extends abiraterone benefit from metastatic HSPC (LATITUDE, STAMPEDE M1) into the high-risk M0 curative setting

    Systemic Curative Meta-analysis Practice-changing

    7 details
    Monday clinic

    In high-risk non-metastatic prostate (node-positive, or node-negative with ≥2 of T3/4, Gleason 8-10, PSA≥40) on definitive RT plus 3yr ADT, this supports adding 2yr abiraterone; it does not extend to intermediate-risk disease.

    Methods
    • 🔍 Meta-analysis pooling 2 randomised phase 3 STAMPEDE trials, N=1974, open-label, 113 UK/Swiss sites, median f/u 72mo
    • 🔍 RT mandated for N0, encouraged for N+; 74Gy/37fx to prostate+SV or hypofrac equivalent; 85% planned RT
    • 💊 Abiraterone 1000mg + prednisolone 5mg daily × 2yr on a 3yr ADT backbone
    • 🔍 39% node-positive; median PSA 34ng/mL; median age 68 (IQR 63-73)
    Results
    • 📊 Combination (abi±enza) vs ADT control — comparison values omitted (cell value "0.53" not verified in source)
    • 📊 6-yr MFS 82% (79-85) combination vs 69% (66-72) control
    • 📊 Adding enzalutamide to abiraterone gave no extra MFS benefit: interaction HR 1.02 (0.70-1.50), p=0.91
    Open questions
    • Optimal abiraterone and ADT duration
    • Abiraterone benefit by nodal status (N0 vs N+)

    Sourced from Attard, Gerhardt et al.

    📚 Sources · 📄 1 paper
    📄 PAPER Attard, Gerhardt; Murphy, Laura; Clarke, Noel W et al. · The Lancet (2022-01)
    Abiraterone acetate and prednisolone with or without enzalutamide for high-risk non-metastatic prostate cancer: a meta-analysis of primary results from two randomised controlled phase 3 trials of the STAMPEDE platform protocol
    doi