More than half of the patients who ultimately die from prostate cancer (PCa) are patients who already have metastases at the time of their diagnosis (de novo metastatic patients).1 Until recently, the treatment of M1 PCa patients consisted of androgen deprivation therapy (ADT). In recent years this treatment paradigm changed following the publication of convincing clinical data demonstrating a significant survival advantage of adding docetaxel or abiraterone acetate (AA) to ADT.2–8 During BMUC 2019, Prof. dr. Karim Fizazi (Institut Gustave Roussy, Paris, France) gave an overview of the latest developments in treatment of M1 PCa patients.