Lugano/Madrid, 24 October 2026 – Adding abiraterone to standard treatment provides a lasting survival benefit for men whose prostate cancer has already spread at diagnosis, reinforcing the value of early treatment intensification. The findings come from almost eight years of follow-up in the academically led phase 3 PEACE-1 trial presented at the ESMO Congress 2026. (1)
For men with de novo metastatic castration-sensitive prostate cancer (mCSPC), treatment is based on androgen deprivation therapy (ADT) to lower testosterone. Adding docetaxel chemotherapy or a second-generation hormonal therapy, such as abiraterone, improves survival, with a direct comparison finding no significant difference in overall survival between the two doublet regimens. (2)
The PEACE-1 trial included 1,173 men with de novo mCSPC. All received standard of care (ADT, with or without docetaxel chemotherapy) and were randomly assigned to receive no additional treatment, abiraterone plus prednisone, radiotherapy to the prostate, or both abiraterone plus prednisone and radiotherapy. Overall, 57% had high-volume disease, indicating more extensive cancer spread. An earlier analysis showed that adding abiraterone to standard of care improved overall survival. (3)
After a median follow-up of 7.7 years, adding abiraterone reduced the risk of death by 25% (hazard ratio [HR] 0.75; 95% confidence interval [CI] 0.65–0.87; p=0.0001). Median overall survival was 6.1 years with abiraterone versus 4.6 years without it.
Among the 710 men who received ADT plus docetaxel (doublet therapy), adding abiraterone plus prednisone (triplet therapy) reduced the risk of death by 32% (HR 0.68; 95% CI 0.56–0.82). Median survival was 6.2 years with triplet therapy versus 4.4 years with doublet therapy, and 40.3% versus 27.1% of men were alive at eight years.
The survival benefit of triplet therapy did not differ significantly by extent of disease (interaction test p=0.56). In men with high-volume disease, median survival was 4.6 years with triplet therapy versus 3.5 years with doublet therapy (HR 0.68; 95% CI 0.54–0.85), and almost twice as many were alive at eight years (38% vs 20%). In men with low-volume disease, median survival was 7.8 years with triplet therapy versus 6.2 years with doublet therapy (HR 0.74; 95% CI 0.52–1.05), although this difference was not statistically significant on its own.
Among men in the control groups whose cancer progressed, 86% went on to receive an androgen receptor pathway inhibitor (ARPI), the same class of treatment as abiraterone. The investigators suggest this supports starting treatment early rather than waiting until progression. No new long-term safety concerns were identified. Among men who received doublet or triplet therapy without radiotherapy, grade 3-4 high blood pressure occurred in 21% with triplet therapy versus 14% with doublet therapy, and grade 3-4 low potassium levels in 4% versus 1%.
“There is a major survival benefit, with almost two years of additional life for patients receiving the three treatments, which is of course highly significant,” said lead author Dr Karim Fizazi, Centre Oscar Lambret, Lille, France. “In our opinion, this makes this triplet treatment a strong standard of care for these patients.”
“Most clinical trials, especially when led by pharma companies, tend to stop their follow-up early,” Fizazi added. “This long-term analysis demonstrated that the survival benefit becomes greater with time: for instance, in men with multiple metastases at diagnosis, there are almost twice as many long-term survivors with triplet therapy.”
“For patients and clinicians, these data mean that modern, intensified systemic treatment – particularly triplet therapy with ADT, docetaxel and abiraterone – can translate into a substantially improved chance of long-term disease control and survival, with toxicity that is generally manageable,” said Dr Ursula Vogl, Oncology Institute of Southern Switzerland (IOSI), Bellinzona, Switzerland, who was not involved in the study.
PEACE-1 did not directly compare triplet therapy with ADT plus a newer hormone therapy without chemotherapy, which is another treatment option. Vogl explained that the decision to add docetaxel therefore depends on individual patient factors, including other health conditions, age and preferences. She emphasised that it remains unclear which patients gain the greatest additional benefit from chemotherapy, highlighting the need for personalised treatment selection.
-END-