Depletion and blockade of androgens has been the standard of care for advanced prostate cancer for the past 70 years, but its role has been limited as far as clinical observations are concerned. Today, the advent of abiraterone acetate appears to be a boon for patients with metastatic prostate cancer. In most patients, chemical denervation can reduce prostate-specific antigen (PSA) concentrations to some extent, resulting in tumor regression and symptomatic relief; however, the effect of this approach is not long-lasting in patients with advanced cancer, and over time, the re-elevation of PSA often signals the reactivation of the androgen receptor, leading to a progressive and fatal state of “denervation resistance” (denervation therapy). The re-elevation of PSA over time often signals the reactivation of the androgen receptor, leading to a progressive and fatal state of “denervation resistance” (the effect of denervation therapy is exhausted). Although many endocrine therapies have been evaluated for efficacy, no approach has been found to improve survival. Fortunately, three non-hormonal therapies, such as polyene paclitaxel (Docetaxel), have been found to extend the life span of patients to some extent. Oncogenomic studies have found that within desmoid-resistant prostate cancer, a specific molecular alteration leads to the upregulation of androgen biosynthetic enzymes, which causes an increase in androgen levels within the tumor, which in turn leads to an increase in blood androgen measurements. If we can find the key step in the androgen synthesis process and block it with drugs, can we achieve better androgen reduction and thus slow down the progression of the disease? Abiraterone acetate could be the drug we are looking for! It is a selective inhibitor of androgen synthesis as a precursor to abiraterone, and it blocks androgen synthesis in the adrenal glands, testes and tumor cells by blocking cytochrome P450c17 (CYP17, a key enzyme in testosterone synthesis). In its Phase 1 and 2 clinical trials, abiraterone acetate had a significant anti-cancer effect in patients with progressive destructive resistant prostate cancer. In this Phase 3 trial, the team hopes to demonstrate that the use of abiraterone acetate and prednisone to inhibit androgen synthesis can improve the overall survival of patients with advanced prostate cancer. Nearly 1,200 patients with advanced prostate cancer who had already received polytene paclitaxel chemotherapy as part of their prior treatment were enrolled in the trial. They were given prednisone twice daily along with the trial drug (abiraterone acetate) or placebo. The primary observed endpoint of the trial was overall survival, and secondary observed endpoints included time to PSA re-elevation, survival without disease progression, and PSA response rate. After a mean follow-up of one year, the overall survival rate was significantly higher in the trial group than in the placebo group, and the mean survival time was 4 months longer than in the placebo group. The trial group still had significant advantages in the secondary observed endpoints of time to PSA re-elevation, survival without disease progression, and PSA response rate (see Figure 1.). It is also worth noting that the treatment effect of the trial group persisted in the majority of subgroups in this trial: the effect of abiraterone acetate in combination with prednisone did not change depending on the patient’s regional origin, age, basal PSA level, basal alkaline phosphatase level, and many other factors (please refer to Figure 2. in the original article for details), and the effect was quite generalized. Although the incidence of common side effects such as fatigue and weakness, back pain, and nausea did not differ significantly between the test and control groups, the incidence of side effects due to elevated salt corticosteroids (fluid retention, hypertension, hypokalemia, etc.) was significantly higher in the test group than in the placebo group. With this study, it was demonstrated that androgen production inhibition using abiraterone acetate can improve overall survival and prolong life expectancy in patients with desmoresistant advanced prostate cancer who have received chemotherapy. This NEJM article does give us new hope! There seems to be a drug available again for the once hopeless advanced prostate cancer. However, the author would like to make a few comments that are related to the article and not to the drug. In recent years, the NEJM has published a large number of drug-related clinical RCT trial results, and if we take out the articles related to drug companies, the impact factor decline is the first among all SCI starting to see. It has even been accused of profiting from it and has been reduced to a billboard for drug companies. The study we see today is also a report on the results of a phase 3 clinical trial for a new drug. Reading through the whole article, one can’t help but think, “This new drug is too good to be true!” It’s so effective and has so few side effects, it’s like a cure for the disease! The contrast between the benefits of the drug and the disadvantages of the drug in clinical use is not described in such a large volume. Of course, perhaps the author is too sensitive, or perhaps the drug does have such a miraculous effect (I hope so); more importantly, we should believe that as an editor of a top international journal, they should choose articles based on science as their primary judgment, rather than the small profits brought by the drug company. However, I still want to share my feelings with readers after reading the article. Putting aside any possible bias, let’s take a final look at the data provided in the article and see what else is noteworthy about abiraterone acetate besides its “miracle” properties. First, the follow-up period in the study was relatively short, and although the drug’s effects were significant, the average increase in life expectancy was 4 months relative to the placebo group. What is the effect of the drug in the context of longer follow-up years? Whether it can lead to a significant increase in five-year survival in patients with advanced prostate cancer remains to be studied further. Second, although the side effects of the drug are covered in the article, the severity of the side effects were relatively low for the results of this study. However, since the side effects of elevated saline corticosteroids are systemic in nature, the impact on the quality of life of patients should be given more consideration.