Abstract
Introduction
To describe the changes in systemic treatments (ST) of synchronous metastatic hormone-sensitive
prostate cancer (mHSPC) patients in a “real-world” setting and to explore reasons
why contemporary standard of care (SOC) was not administrated to the patient.
Patients and methods
Since 2014, we prospectively register mHSPCpatients. Patients were grouped in 4 time
periods: group 1 (Time period 1, January 2014-July 2015), group 2 after introduction
of docetaxel (Time period 2, August 2015-July 2017), group 3 after introduction of
abiraterone acetate (Time period 3, August 2017-February 2018) and group 4 after introduction
of apalutamide (Time period 4, March 2018-October 2021). For every time period, we
evaluated the initiated additional ST. In case patients received treatment that differed
from contemporary SOC according to guidelines, reasons for this difference were explored.
Results
In total, 243 patients were included. A progressive decline in ADT monotherapy from
85% to 29% over time was observed. The proportion of patients receiving additional
STs increased from 34% to 59%. Forty percent of patients were not treated according
to contemporary SOC, but this percentage varied strongly per time period (10%, 67%,
53%, and 32% from time period 1 to time period 4 respectively). Reasons for these
variations were heterogenous and varied across the 4 time periods. Patients being
unfit for treatment and treating physicians failing to consider additional STs were
the most prevalent reasons. The proportion of patients unfit for additional ST decreased
from 18% to 4% over time.
Conclusion
Use of ADT monotherapy declined gradually after the introduction of additional systemic
treatments. The proportion of patients unfit for additional ST declined as more treatments
became available. Although compliance to SOC increased over time, these real-world
data show that adherence to clinical practice guidelines remains suboptimal. Efforts
should be made by clinicians to increase the adherence to practice guidelines.
Keywords
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Article info
Publication history
Published online: November 13, 2022
Accepted:
November 2,
2022
Received in revised form:
October 30,
2022
Received:
May 28,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2022 Published by Elsevier Inc.
