1.1 Abiraterone with prednisone or prednisolone plus androgen deprivation therapy (ADT) is not recommended, within its marketing authorisation, for treating newly diagnosed high-risk hormone‑sensitive metastatic prostate cancer in adults.
1.2 This recommendation is not intended to affect treatment with abiraterone with prednisone or prednisolone plus ADT that was started in the NHS before this guidance was published. People having treatment outside this recommendation may continue without change to the funding arrangements in place for them before this guidance was published, until they and their NHS clinician consider it appropriate to stop.
Why the committee made these recommendations
Treatment for newly diagnosed high-risk hormone-sensitive metastatic prostate cancer in the NHS in England includes ADT alone, docetaxel plus ADT and, as of July 2021, enzalutamide plus ADT.
Clinical trial results show that, compared with ADT alone, a combination of abiraterone plus ADT and either prednisone or prednisolone increases the time until the disease progresses and how long people live. Results also show that, compared with docetaxel plus ADT, abiraterone plus ADT increases the time until the disease progresses, but not how long people live. Docetaxel plus ADT cannot be used by or is unsuitable for some people but there is no clinical evidence for abiraterone plus ADT compared with ADT alone for this group.
There is a proposed commercial arrangement that would make abiraterone available to the NHS at a discount. Even accounting for this, the cost-effectiveness estimates of either abiraterone in combination compared with ADT alone or with docetaxel plus ADT for the whole population are higher than what NICE considers cost effective. There are no appropriate cost-effectiveness estimates for when docetaxel cannot be used or is unsuitable. Therefore, abiraterone is not recommended for treating newly diagnosed high-risk hormone-sensitive metastatic prostate cancer.