Monitoring prostate cancer under androgen-deprivation therapy: insights from the implementation of a clinical...

Clinical Decision Support Systems (CDSS) assist clinicians in making informed decisions based on clinical guidelines and comprehensive data. In prostate cancer (PC), particularly in patients receiving androgen deprivation therapy (ADT), early detection of castration-resistant prostate cancer (CRPC) and close monitoring of progression biomarkers are essential. This study evaluated the impact of a CDSS on the monitoring and clinical management of advanced PC patients in a hospital setting.

A retrospective, single-centre cohort study was conducted using structured patient-level data from the institutional Data Warehouse of Hospital La Fe (Valencia, Spain). The study included patients diagnosed with PC who received ADT and were analysed over two consecutive one-year periods: 15 September 2021 to 14 September 2022 (pre-implementation) and 15 September 2022 to 15 September 2023 (post-implementation of the CDSS). Primary outcomes included CRPC detection rates, classification of PSA kinetics instability, and use of palliative radiotherapy.

CDSS implementation was associated with higher CRPC detection rates (from 20.7% to 27.9%). The proportion of patients with unstable PSA kinetics increased after implementation (81.1% vs. 64.7%; p = 0.01). Although the increase in the use of palliative radiotherapy did not reach statistical significance, a modest rise was observed (from 11.7% to 15.1%).

The introduction of the CDSS was associated with improved monitoring signals and earlier recognition of disease progression in ADT-treated patients. The system supported enhanced PSA-based risk stratification and more timely multidisciplinary coordination. Although longer follow-up and broader implementation are needed to confirm trends, the findings highlight the potential of digital tools to optimize routine PC management.