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

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

ID	`RF-LATITUDE-HIGH-RISK-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 LATITUDE high-risk criteria — ≥2 of (Gleason ≥8, ≥3 bone metastases, visceral metastases) — supports abiraterone + ADT doublet (or triplet with docetaxel where high-volume by CHAARTED also met)
Clinical direction	intensify
Category	risk-score
Shifts algorithm	ALGO-PROSTATE-MHSPC-1L

Trigger Logic

{
  "any_of": [
    {
      "finding": "prostate_latitude_risk",
      "value": "high"
    },
    {
      "all_of": [
        {
          "comparator": ">=",
          "finding": "prostate_high_risk_factor_count",
          "threshold": 2
        }
      ]
    }
  ],
  "type": "composite_clinical"
}

Notes

LATITUDE (Fizazi NEJM 2017) defined high-risk as ≥2 of: Gleason ≥8, ≥3 bone mets, presence of visceral mets. The high-risk cohort showed 4-yr OS improvement with abiraterone + ADT vs ADT alone (HR 0.62). NCCN / ESMO / EAU 2024 endorse abiraterone + ADT as standard for LATITUDE high-risk. Co-fires with RF-CHAARTED-HIGH-VOLUME-MHSPC; when both fire, PEACE-1 / ARASENS data support adding docetaxel for triplet. Direction `intensify` toward ADT + ARSI (abiraterone preferred per LATITUDE; apalutamide / enzalutamide also acceptable per TITAN / ENZAMET) over ADT monotherapy. Composite trigger uses pre-computed prostate_high_risk_factor_count when available; otherwise individual factor flags can be assessed by extending the trigger schema later.

Used By

Algorithms

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

Red flag

RF-CHAARTED-HIGH-VOLUME-MHSPC - Metastatic hormone-sensitive prostate cancer meeting CHAARTED high-volume criteria — visc...