LATITUDE: What the Prostate Cancer Trial Found

The moment the standard changed

For decades, a new diagnosis of metastatic prostate cancer led to hormone therapy on its own. Stronger drugs were held back for when that stopped working. LATITUDE tested the opposite idea: give a potent androgen-blocking drug straight away, at the start.

What counted as high risk

1,199 men joined. All had newly diagnosed prostate cancer with metastases, and none had yet had hormone therapy for it.

They also had to be high risk, which the trial defined precisely: at least two of three features. A Gleason score of 8 or more. Three or more lesions on a bone scan. Or measurable spread to an organ other than lymph nodes.

597 men received hormone therapy plus abiraterone acetate and prednisone. 602 received hormone therapy plus two matching placebos.

The interim result that ended the blinding

At a planned interim look, after a median follow-up of 30.4 months and 406 deaths, the abiraterone group had not yet reached its median survival. The placebo group had, at 34.7 months. The hazard ratio for death was 0.62 (95% CI 0.51 to 0.76; p<0.001) — about a 38% lower risk of dying at any moment.

Time before the cancer visibly grew on scans was 33.0 months against 14.8 months (hazard ratio 0.47; 95% CI 0.39 to 0.55; p<0.001). More than double.

The monitoring committee judged the gap large enough that the trial should be unblinded, so men on placebo could switch to abiraterone.

The final figures

The final analysis came after a median follow-up of 51.8 months and 618 deaths. Median overall survival was 53.3 months with abiraterone against 36.5 months with placebo, hazard ratio 0.66 (95% CI 0.56 to 0.78; p<0.0001). A gap of nearly 17 months.

What abiraterone asks of the person taking it

Abiraterone is not a simple addition. It comes with daily prednisone, a steroid, and it needs regular monitoring.

In the final report, severe high blood pressure affected 21% of the abiraterone group against 10% on placebo. Low potassium affected 12% against 2%. Liver effects are also watched for. These are manageable, but they mean blood tests and appointments that would not otherwise happen.

What this trial cannot tell you about your own case

• It enrolled only high-risk metastatic disease, by that specific definition. It does not answer the question for men with fewer or smaller metastases.
• It did not compare abiraterone with docetaxel chemotherapy, the other treatment already known to help at this stage.
• Once the trial was unblinded, men on placebo could cross over. That complicates the long-term comparison.
• Median survival describes the middle of a large group, not any one man's outlook.

Questions at a new metastatic diagnosis

• Does my cancer meet the high-risk definition used in this trial?
• What are my options for adding a drug to hormone therapy now, and how do they compare?
• What monitoring would abiraterone and prednisone require?
• How would we decide between this and chemotherapy?

Sources

This article was written from the sources below, which were checked on the source-check date shown above.

• NEJM: Abiraterone plus Prednisone in Metastatic, Castration-Sensitive Prostate Cancer (LATITUDE) (primary)
• Lancet Oncology: LATITUDE final overall survival analysis (primary)

How this article was prepared

Prepared by Cancer Explained's AI-assisted editorial system and checked against the sources listed below. This article has not been reviewed by a healthcare professional unless a named reviewer is specifically shown.

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