Understanding management strategies for metastatic hormone-sensitive prostate cancer: A multidisciplinary survey in...

Metastatic hormone-sensitive prostate cancer (mHSPC) is increasingly diagnosed due to advancements in imaging and screening. Current guidelines recommend intensified androgen deprivation therapy (ADT) as standard of care, with treatment strategies tailored according to disease burden and patient characteristics. This study aimed to explore mHSPC management practices in France through a national clinician survey and multidisciplinary consultation meeting (MCM) discussions, identifying treatment strategies and alignment with guidelines.

A two-part questionnaire, developed by a multidisciplinary scientific committee, was distributed to clinicians across France, collecting data on clinician profiles and treatment approaches, including five clinical case scenarios. Additionally, six theoretical cases were discussed in MCMs held across 10 centers to assess collaborative decision-making.

Among 143 respondents, 53% were urologists, 22% radiation oncologists, and 25% medical oncologists, with broad regional distribution. Respondents reported managing a median of 30 mHSPC patients annually. Most adhered to national guidelines, though treatment strategies showed variability. Doublet therapy (ADT+ARPI) was widely used, while triplet therapy (ADT+ARPI+docetaxel) was more frequently considered for patients with poor prognostic disease features (e.g., high tumor volume) or younger age. In contrast, ADT alone was typically preferred for frailer patients. MCM discussions promoted greater alignment with guideline-based care.

This study reveals real-world variability in mHSPC management in France, driven by clinical judgment and patient-specific factors. Multidisciplinary collaboration was critical for consistency and personalized care. Ongoing efforts should focus on addressing practice variability, incorporating patient preferences, and integrating emerging therapies to improve outcomes while minimizing loss of therapeutic opportunity.

(HAS): 4 (descriptive studies, surveys, expert opinions).