Comparing the Efficacy and Safety of Rezvilutamide+ADT+Docetaxel Versus Rezvilutamide +ADT in the mHSPC

To investigate the value of chemotherapy in the treatment of high-burden of mHSPC on the background of next-genertion of AR inhibitors.

Inclusion criteria

• Males aged ≥40 years and ≤80 years.
• Histologically or cytologically confirmed prostate adenocarcinoma.
• Metastatic disease.
• Eligible for ADT and Docetaxel.
• Started or not started first-generation androgen deprivation therapy (ADT), but not exceeding 12 weeks before randomization.
• ECOG score of 0 or 1.
• Laboratory tests meet the following requirements:

• Hematology: neutrophils ≥1.5×10^9/L, platelets ≥100×10^9/L, hemoglobin ≥9g/dL.
• Renal function: serum creatinine ≤1.5× upper limit of normal (ULN).
• Liver function: aspartate aminotransferase (AST) and alanine aminotransferase (ALT) ≤2.5× ULN, total bilirubin (TBIL) ≤1.5× ULN.
• Coagulation function: international normalized ratio (INR) <1.5.
• Study subjects: Patients with mHSPC have a confirmed pathology of prostate adenocarcinoma with high tumor burden, which is defined by having at least one of the following conditions:

• Bone scan showing ≥4 bone metastatic lesions (with at least one site outside the pelvis or spine).

• CT/MRI revealing visceral metastatic lesions (excluding lymph nodes).

Exclusion criteria

Patients who meet any of the following criteria are not eligible to participate in this study:

• Prior use of LHRH agonists/antagonists; second-generation androgen receptor (AR) inhibitors such as enzalutamide, ARN-509, darolutamide (ODM-201), or other investigational AR inhibitors; CYP17 enzyme inhibitors such as abiraterone acetate or oral ketoconazole for anti-tumor treatment of prostate cancer; chemotherapy or immunotherapy for prostate cancer prior to randomization.
• Received radiation therapy/radiopharmaceutical treatment within 2 weeks before randomization.
• Any of the following conditions within 6 months before randomization: stroke, myocardial infarction, severe/unstable angina pectoris, coronary artery/peripheral artery bypass surgery, congestive heart failure (New York Heart Association class III or IV).
• Previous malignancy, except adequately treated basal cell carcinoma or squamous cell carcinoma of the skin or superficial bladder cancer not invading the deeper muscle layer (i.e., pTis, pTa, and pT1) and any other cancer in complete remission for at least 5 years before randomization.
• Gastrointestinal diseases or procedures that are expected to significantly interfere with the absorption of study treatment.
• Inability to take oral medication.