In patients with low-volume mHSPC, enzalutamide was the best option in terms of OS and PFS. Regarding AEs, apalutamide was the likely best option among the three ARIs. Abiraterone (HR 0.71, 95% CrI 0.67–0.76), apalutamide (HR 0.73, 95% CrI 0.65–0.81), docetaxel (HR 0.84, 95% CrI 0.78–0.90), and enzalutamide (HR 0.67, 95% CrI 0.63–0.71) were associated with significantly better PFS than ADT, and enzalutamide emerged as the best option. Abiraterone (hazard ratio 0.83, 95% credible interval 0.76–0.90), docetaxel (HR 0.90, 95% CrI 0.82–0.98), and enzalutamide (HR 0.85, 95% CrI 0.73–0.99) were associated with significantly better OS than androgen-deprivation therapy (ADT), and abiraterone emerged as the best option. Nine studies ( N = 9960) were selected, and formal network meta-analyses were conducted. Studies comparing overall/progression-free survival (OS/PFS) and/or adverse events (AEs) in patients with mHSPC were eligible.
Multiple databases were searched for articles published before May 2020 according to the Preferred Reporting Items for Systematic Review and Meta-analysis extension statement for network meta-analysis. To perform a systematic review and network meta-analysis to compare the efficacy and safety of currently available treatments for the management of metastatic hormone-sensitive prostate cancer (mHSPC), as there has been a paradigm shift with the use of next-generation androgen receptor inhibitors (ARIs) and docetaxel.