# STAMPEDE: abiraterone with or without enzalutamide added to androgen deprivation for high-risk non-metastatic prostate cancer

Source: https://onco.cc/key-papers/paper-stampede-abiraterone-high-risk-attard-lancet-2022/  
OnCo record `paper-stampede-abiraterone-high-risk-attard-lancet-2022` (Key paper). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Adding two years of abiraterone to hormone therapy and radiotherapy for high-risk localised or node-positive prostate cancer halved the risk of metastases and cut deaths by 40 percent, while adding enzalutamide on top brought only extra toxicity.

## Summary

Meta-analysis of two STAMPEDE comparisons including 1,974 men with high-risk non-metastatic prostate cancer (node-positive, or node-negative with at least two of T3/4, Gleason 8 to 10, PSA 40 or more) randomised to androgen deprivation with or without two years of abiraterone (with enzalutamide in the second comparison).

Six-year metastasis-free survival was 82 versus 69 percent (hazard ratio 0.53) and overall survival 86 versus 77 percent (hazard ratio 0.60); enzalutamide added toxicity without efficacy.

## Fields

- Kind: Key paper
- Last checked: 2026-09-17
- Journal: The Lancet
- Year: 2022
- DOI: 10.1016/S0140-6736(21)02437-5
- Authors: Attard G, Murphy L, Clarke NW, et al.
- Findings: Six-year metastasis-free survival 82 percent vs 69 percent; hazard ratio 0.53.; Six-year overall survival 86 percent vs 77 percent; hazard ratio 0.60.
- What it means: Two years of abiraterone with androgen deprivation and radiotherapy is the standard for very high-risk and node-positive localised prostate cancer.
- Caveats: Most men received radiotherapy; benefit after prostatectomy is less certain.; Staging was by conventional imaging.

## Sources

- Lancet 2022: https://doi.org/10.1016/S0140-6736(21)02437-5
- PubMed: https://pubmed.ncbi.nlm.nih.gov/34953525/

## Connected records

- cancers: [Localised prostate cancer, high and very high risk](https://onco.cc/cancers/prostate-high-risk/)
- drugs: [Abiraterone acetate](https://onco.cc/drugs/abiraterone/), [Enzalutamide](https://onco.cc/drugs/enzalutamide/)
- trials: [STAMPEDE](https://onco.cc/trials/stampede/)
- journals: [The Lancet](https://onco.cc/journals/lancet/)

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