(UroToday.com) Metastatic prostate cancer continues to be driven by androgen signaling, in part through androgen synthesis via CYP17A1 lyase activity. Abiraterone acetate is an FDA-approved inhibitor of CYP17 hydroxylase and lyase activity that has shown clinical benefit when added to chemical castration in advanced prostate cancer but results in mineralocorticoid excess due to inhibition of hydroxylase activity that requires concomitant prednisone treatment. TAK-700, also called orteronel, is a specific inhibitor of CYP17 lyase activity that does not lead to secondary mineralocorticoid excess and does not always require prednisone. In this study, Dr. Neeraj Agarwal and colleagues evaluated the hypothesis that the addition of TAK-700 to testosterone suppression would improve survival over testosterone suppression and bicalutamide in metastatic castration-sensitive prostate cancer (mHSPC).