Prostate cancer

NEW---High-risk non-metastatic prostate cancer

Earn accreditation points

Finish 5 case(s) answer 10 question(s) and Earn 1 credit.


Educational Objective: To provide insight into factors determining treatment appropriateness in high-risk non-metastatic prostate cancer (PCa). To clarify the role of systemic therapy in clinical practice for this patient population.
Specialty: Urology, Medical oncology, Radiation oncology, Clinical oncology
Target Audience: Specialists (CME: intermediate, advanced), Residents (senior)
Latest update: May 2024

Most patients with high-risk PCa will need a multimodal treatment approach. However, not all high-risk patients are at the same risk of disease progression or death.

Definitions of (very) high-risk PCa according to international guidelines and inclusion criteria of the STAMPEDE trial

T stage definition based on DRE; N stage definition based on CT scan. DRE: digital rectal examination; ECOG PS: Eastern Cooperative Oncology Group performance status, ISUP GG: International Society of Urological Pathology grade group, PSA: prostate-specific antigen

Abiraterone is approved in the metastatic PCa setting only. The European Medicines Agency (EMA) [4] approved abiraterone in combination with prednisone or prednisolone in patients with:

  • newly diagnosed high-risk metastatic hormone-sensitive PCa (mHSPC) in combination with androgen deprivation therapy (ADT)
  • metastatic castration-resistant PCa (mCRPC) who are asymptomatic or mildly symptomatic after failure of ADT in whom chemotherapy is not yet clinically indicated
  • mCRPC whose disease has progressed on or after a docetaxel-based chemotherapy regimen

The Food and Drug Administration (FDA) approved abiraterone in combination with prednisone for the treatment of patients with mCRPC and patients with high-risk mHSPC [5].

The treatment options were rated in November 2023, before publication of the 2024 updates of the EAU and NCCN guidelines.



  1. Cornford P, Tilki D, van den Bergh RCN, et al. European Association of Urology (EAU)-European Association of Nuclear Medicine (EANM)-European Society for Radiotherapy & Oncology (ESTRO)-European Society of Urogenital Radiology (ESUR)-International Society of Urological Pathology (ISUP)-International Society of Geriatric Oncology (SIOG) guidelines on prostate cancer. Update April 2024. Available at:
  2. Schaeffer EM, Srinivas S, Adra N, et al. National Comprehensive Cancer Network clinical practice guidelines in oncology: Prostate cancer. Version 3.2024. Available at:
  3. James ND, Sydes MR, Clarke NW, et al. Lancet 2016;387:1163-77. PubMed
  4. Abiraterone summary of product characteristics (EMA). Last accessed on 15 April 2024:
  5. Abiraterone summary of product characteristics (FDA). Last accessed on 15 April 2024: