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Uptake of doublet and triplet therapy for men with de novo metastatic castration-sensitive prostate cancer.

Paolo Zaurito1, Rolf Gedeborg2, Hans Garmo2

  • 1Department of Surgical Sciences, Uppsala University, Uppsala, Sweden; Division of Experimental Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy.

Scandinavian Journal of Urology
|March 17, 2026
PubMed
Abstract

Insights

Uptake of doublet and triplet therapies for metastatic castration-sensitive prostate cancer (mCSPC) significantly increased, particularly in younger men. This rise in advanced treatments correlated with improved 3-year overall survival rates for mCSPC patients.

Area of Science:

  • Oncology
  • Clinical Medicine
  • Prostate Cancer Research

Background:

  • Randomized trials demonstrate improved survival with doublet and triplet therapies over standard androgen deprivation therapy (ADT) for de novo metastatic castration-sensitive prostate cancer (mCSPC).
  • Clinical guidelines now recommend doublet therapy (since 2020) and triplet therapy (since 2022) for mCSPC.
  • Assessing population-level uptake and survival trends is crucial for evaluating treatment impact.

Purpose of the Study:

  • To evaluate the real-world uptake of upfront doublet and triplet therapies in men with de novo mCSPC.
  • To analyze survival trends for all men diagnosed with de novo mCSPC during the study period.

Main Methods:

  • Analysis of 9294 men with de novo mCSPC from the National Prostate Cancer Register of Sweden (2016-2024).
  • Estimation of annual proportions receiving upfront doublet (ADT + ARPI or docetaxel) or triplet (ADT + docetaxel + ARPI) therapy.
  • Kaplan-Meier curves used to estimate 3-year overall survival rates.

Main Results:

  • Uptake of upfront doublet therapy increased from 19% (2016) to 66% (2024); triplet therapy rose from 4% (2021) to 17% (2024).
  • Treatment uptake was highest in men under 65, with 46% receiving doublet and 48% receiving triplet therapy in 2024.
  • Three-year overall survival increased from 51% (2016-2018) to 61% (2022-2024) across all mCSPC patients, and from 69% to 77% in men under 65.

Conclusions:

  • Substantial increase in doublet and triplet therapy uptake observed, especially in younger mCSPC patients.
  • Concurrent rise in 3-year overall survival rates for de novo mCSPC patients.
  • Findings support the clinical benefit of upfront doublet or triplet therapy in managing mCSPC.

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