A 68-year-old male with prostate cancer has PSA 22 ng/mL, Gleason score 4+4=8, and a bone scan showing 2 pelvic lymph node metastases but no bone metastases. He is ECOG 0. According to EAU/NCCN guidelines, what is the current standard of care?
- A Androgen deprivation therapy (ADT) alone for 2 years
- B ADT + docetaxel chemotherapy (CHAARTED regimen)
- C Radical prostatectomy with pelvic lymph node dissection
- D ADT + abiraterone acetate + prednisolone (LATITUDE trial) ✓
Explanation
The LATITUDE trial demonstrated that in patients with newly diagnosed high-risk metastatic hormone-sensitive prostate cancer (mHSPC), adding abiraterone acetate + prednisone to ADT significantly improved overall survival versus ADT alone. High-volume disease (CHAARTED criteria: ≥4 bone metastases or visceral metastases) supports docetaxel addition. Node-only metastatic disease with high-risk features (Gleason 8+) supports intensified therapy. Current guidelines recommend combination ADT + novel hormonal agent (abiraterone, enzalutamide, or apalutamide) as standard for newly diagnosed mHSPC, with docetaxel as an alternative, especially in fit patients with high-volume disease.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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