Physician Reasons for or Against Treatment Intensification in Patients With Metastatic Prostate Cancer

Area of Science:

• Oncology
• Clinical Practice Research

Background:

• Treatment intensification (TI) for metastatic castration-sensitive prostate cancer (mCSPC) is recommended by evidence-based guidelines.
• Underutilization of TI may lead to suboptimal survival outcomes for mCSPC patients.

Purpose of the Study:

• To investigate physician beliefs and identify barriers to treatment intensification in mCSPC.
• To understand the gap between clinical practice and evidence-based guidelines for mCSPC.

Main Methods:

• A retrospective survey study linked physician surveys with medical record reviews of US patients with mCSPC.
• Data were collected on patient demographics, clinical characteristics, and physician prescribing decisions.
• Bivariate and multivariable analyses assessed factors associated with first-line TI, with odds ratios (ORs) as the main outcome measure.

Main Results:

• Nearly 70% of mCSPC patients did not receive first-line TI (androgen receptor pathway inhibitors and/or chemotherapy).
• Physicians cited tolerability concerns and guideline adherence as top reasons for treatment choices.
• Physicians aiming for greater prostate-specific antigen (PSA) reduction and those basing treatment on guidelines were more likely to use TI.

Conclusions:

• Low rates of first-line TI for mCSPC persist despite guideline recommendations.
• Barriers include lack of knowledge regarding guidelines and efficacy/safety data.
• Physician education on guidelines and clinical trial data may increase TI utilization and improve patient outcomes.