[Management of metastatic hormone-naive prostate cancer at diagnosis]

In Belgium, 12 % of patients present with upfront metastatic hormone-naive prostate cancer. Surgical or medical castration has been the only approved treatment for decades. Since 2014, several randomized trials have demonstrated that survival could be significantly improved in patients who are deemed fit enough to cope with the potential added side-effects. Docetaxel chemotherapy and androgen receptor axis-targeted next generation hormonal agents such as abiraterone, enzalutamide and apalutamide have been shown to improve overall survival when given within 12 weeks after castration initiation. Similarly, prostate radiotherapy, in the absence of urological contraindications, might also improve overall survival in patients presenting with less than 5 bone metastases. How these strategies can be combined remains a matter of debate and is currently under investigation.