OBJECTIVES: To determine benefit of AA+P when added to ADT by evaluating EQ-5D-5L visual analog scale (VAS) time to deterioration, assessing clinically relevant minimally important differences (MIDs), in the LATITUDE study of patients with mHSPC. METHODS: Patients were randomized 1:1 to ADT+AA+P (n = 597) or ADT+placebos (PBOs) (n = 602). EQ-5D-5L responses were collected at baseline, Day 1 (Cycles 2-13), and then bimonthly (Cycles 14+) until radiographic or clinical disease progression, and then every 4 months for 12 months post-progression. Time-to-event analyses were performed using Kaplan-Meier and Cox proportional hazards model to evaluate AA+P treatment effect. Subgroup analysis was done by baseline characteristics including age, Eastern Cooperative Oncology Group performance status, Gleason score at initial diagnosis, bone lesion number, prostate-specific antigen, lactate dehydrogenase, region, and use of bone-modifying or analgesic concomitant medication. Clinically relevant MIDs for EQ-5D-5L VAS—seven (T7) and ten (T10) points—as estimated by Pickard et al. (Health Qual Life Outcomes