Treatment intensification in metastatic castration-sensitive prostate cancer: a real-world study in Alberta, Canada

To assess the current status of and factors associated with treatment intensification (TI) (with androgen receptor pathway inhibitors [ARPIs] and/or docetaxel) for metastatic castration-sensitive prostate cancer (mCSPC) in Canada.

Retrospective analysis of data for 431 patients with mCSPC from the Alberta Prostate Cancer Research Initiative database (July 2014-March 2022). The primary objective was to assess the patient proportion receiving TI, time to TI, and associated factors. The secondary and exploratory objectives were evaluating TI patterns and factors associated with choice of therapy, respectively.

Overall, 42% of patients received TI; most (65%) within 3 months post-index. TI was likely to occur within 3 months post-index in de novo mCSPC, but occurred later for recurrent mCSPC. Patients with recurrent mCSPC (HR [95% CI]: 0.52 [0.38-0.72]) and those aged ≥ 75 years (0.57 [0.36-0.93]) were less likely to receive TI. Patients with multiple metastatic sites and bone metastasis had a 2-3-fold higher likelihood of receiving TI. An ARPI was predominantly used (75%) for TI (median duration: 16.0 months).

TI rates for mCSPC are suboptimal in Canada especially for older patients and those with recurrent mCSPC. TI prioritization in such groups may improve patient outcomes.