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.
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%. Fourty 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.
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.
In the last decade, a shift has occurred in the treatment of patients with newly diagnosed
metastatic prostate cancer (ndMPC) from ADT monotherapy to early combination therapies
of ADT with docetaxel or ARTAs. Although the introduction of novel systemic therapies
has made more patients eligible for additional treatments, adherence to clinical practice
guidelines remains suboptimal.