@jeffmarc wrote "My understanding is that abiraterone Along with ADT can also delay castrate resistance."

Yes, you're right. That was the LATITUDE study that I mentioned. The results weren't as dramatic as ADT+Apalutamide in the TITAN study, but they were still a solid improvement over ADT alone.

There have been similar studies showing the benefits of Enzalutamide (ARCHES, ENZAMET) and later, for Darolutamide (ARONOTE) as first-line treatments in doublet therapy for mCSPC, rather than sequencing them later.

All showed stunning improvements, both for overall survival (OS) and progression-free survival. TITAN, for example, failed to reach media OS during its 4½ years — too many patients in the study group insisted on staying alive. 🙂

Caveat: while all the studies required patients to be have mCSPC and not to have taken an ARSI before (I think), they mostly didn't require patients to be newly diagosed. That means that the tine to progression-free survival and overall survival are likely *understated,* since study participants may have had mCSPC already for months before the studies started, and may even have had chemo.