ESMO Congress 2026

The role of abiraterone acetate plus prednisone in de novo metastatic castration-sensitive prostate cancer (mCSPC) is the focus of the long-term follow-up update of the phase 3 PEACE-1 trial (Abstract 2215O, presented by Prof. Karim Fizazi) at the ESMO 2026 congress. It should be noted that the background literature provided with this material is a systematic review in the field of coronary physiology assessment ^[1], with no direct relevance to prostate cancer, so this interpretation does not elaborate on it; previously published phase 3 evidence for the abiraterone class in mCSPC is not included in this material (to be confirmed), and the following content is strictly limited to what the on-site posts disclosed.

PEACE-1 used a 2×2 factorial design (N=1,173), randomly adding abiraterone + prednisone and/or prostate radiotherapy to standard of care (ADT ± docetaxel), with a median follow-up of 7.7 years reported this time. In the overall population, the OS HR with abiraterone was 0.75 (95% CI 0.65–0.87, p=0.0001), with median OS of 6.1 vs 4.6 years and a sustained 25% relative reduction in the hazard of death. In the triplet comparison (N=710, ADT + docetaxel + abiraterone vs ADT + docetaxel), median OS was 6.2 vs 4.4 years, HR 0.68 (95% CI 0.56–0.82), an additional 1.8 years in median survival; 8-year OS was 40.3% with the triplet vs 27.1% with the doublet, an absolute difference of 13.2 percentage points.

Stratified by metastatic volume: in high-volume disease, median OS was 4.6 vs 3.5 years, HR approximately 0.68 (recorded as 0.67 in another on-site post); in low-volume disease, 7.8 vs 6.2 years, HR 0.74 (95% CI 0.52–1.05), with the CI crossing 1; there was no significant interaction by disease volume (p=0.56). Relative to existing understanding, the step forward of this readout is that 7.7 years of mature follow-up answers whether upfront intensification translates into durable survival: the benefit is not limited to early response or surrogate endpoints but is reflected in clinically meaningful long-term survival outcomes, reinforcing the rationale for upfront triplet therapy in de novo mCSPC patients fit for docetaxel.

The limitations are also stated openly: the low-volume subgroup CI crossed 1, and the absence of a significant interaction does not mean identical benefit in both subgroups, so cautious interpretation is needed; the presenter also noted that the clinical question is increasingly not simply whether to intensify, but which patients should receive a triplet, how best to integrate local prostate treatment, and how to preserve quality of life — none of which are answered by these data.