← Back to The Absolute Effect
Prostate Cancer · Medical Oncology

STAMPEDE — Abiraterone comparison

In men starting long-term ADT with metastatic prostate cancer, does abiraterone + prednisolone improve survival?

Population
1,917 men randomized in the abiraterone comparison; 52% had metastatic disease and most had newly diagnosed disease.
Treatment
Standard of care including long-term ADT ± indicated local treatment versus standard of care plus abiraterone 1,000 mg daily + prednisolone 5 mg daily.
5-year OS
60% vs 41% in metastatic disease; absolute benefit 19 points; NNT ≈6.
Long-term OS
At 6.1 years median follow-up, OS HR 0.60 (95% CI 0.50–0.71), P<0.001.

Absolute Effect

Metastatic subgroup: The 5-year survival estimate increased from 41% to 60%. Benefit was similar in low-risk and high-risk metastatic disease: HR 0.55 and 0.54 respectively in the 5-year analysis.

Failure-free outcomes: Abiraterone substantially delayed treatment failure; the platform's composite failure-free endpoint includes progression, new therapy, or death.

Safety/burden: At 4 years, grade ≥3 toxicity was reported by 16% in each group in the 5-year follow-up report. Earlier analyses identified hypertension, cardiac/hepatic and mineralocorticoid-related effects as important treatment-specific toxicities.

Interpretation & limitations

STAMPEDE is a platform trial with evolving standard-of-care components. The metastatic survival benefit persisted beyond 7 years in later follow-up, but the absolute 5-year value is tied to the metastatic subgroup and should not be generalized to all enrolled patients.

Primary sources

James ND, et al. N Engl J Med. 2017;377:338–351. Attard G, et al. Lancet. 2023;401:1211–1222.

Read the 5-year follow-up →

Current-practice context · reviewed 14 October 2026

For newly diagnosed metastatic hormone-sensitive prostate cancer, adding abiraterone plus prednisone to ADT improves survival and is a standard intensification option for suitable patients. Modern decisions compare available androgen-receptor pathway inhibitor doublets and docetaxel-based triplets, considering disease burden, cardiovascular/metabolic risk, drug interactions, cost and patient preference; do not use ADT alone for a fit patient without a reason to de-intensify.

STAMPEDE abiraterone comparison primary report ↗ · Current guideline guidance ↗