Metastatic hormone-sensitive prostate cancer meeting CHAARTED high-volume criteria — visc...

Deterministic view of the source YAML entity. Clinical authority remains with the cited source IDs and reviewer sign-off state.

ID	`RF-CHAARTED-HIGH-VOLUME-MHSPC`
Type	Red flag
Status	reviewed 2026-04-27 \| pending_clinical_signoff
Diseases	`DIS-PROSTATE`
Sources	`SRC-EAU-PROSTATE-2024` `SRC-ESMO-PROSTATE-2024` `SRC-NCCN-PROSTATE-2025`

Red Flag Origin

Definition	Metastatic hormone-sensitive prostate cancer meeting CHAARTED high-volume criteria — visceral metastases OR ≥4 bone metastases with at least 1 outside vertebral column / pelvis — supports docetaxel + ADT triplet (with or without darolutamide / abiraterone)
Clinical direction	intensify
Category	risk-score
Shifts algorithm	ALGO-PROSTATE-MHSPC-1L

Trigger Logic

{
  "any_of": [
    {
      "finding": "prostate_chaarted_volume",
      "value": "high"
    },
    {
      "finding": "visceral_metastases_present",
      "value": true
    },
    {
      "all_of": [
        {
          "comparator": ">=",
          "finding": "bone_metastases_count",
          "threshold": 4
        },
        {
          "finding": "bone_metastases_outside_axial",
          "value": true
        }
      ]
    }
  ],
  "type": "composite_clinical"
}

Notes

CHAARTED (Sweeney NEJM 2015) defined high-volume as visceral mets OR ≥4 bone mets with ≥1 outside vertebrae and pelvis. High-volume cohort showed 17-mo OS improvement with docetaxel + ADT vs ADT alone (HR 0.60). ARASENS (Smith 2022) extended to triplet darolutamide + docetaxel + ADT with further OS benefit (HR 0.68 for OS) — high-volume preferred for triplet. PEACE-1 (Fizazi 2022) showed similar for abiraterone + docetaxel + ADT. Direction `intensify` toward triplet over doublet ADT+ARSI alone in CHAARTED high-volume. Co-fires with RF-LATITUDE-HIGH-RISK-MHSPC for LATITUDE high-risk overlap; triplet preferred when both fire.

Used By

Algorithms

ALGO-PROSTATE-MHSPC-1L - ALGO-PROSTATE-MHSPC-1L

Red flag

RF-LATITUDE-HIGH-RISK-MHSPC - Metastatic hormone-sensitive prostate cancer meeting LATITUDE high-risk criteria — ≥2 of...