Real-World Treatment Patterns for Patients with High-Risk Biochemically Recurrent Nonmetastatic Castration‑Sensitive Prostate Cancer.

Abstract

Based upon recent phase 3 trials, guidelines recommend early aggressive treatment for patients with high-risk biochemically recurrent nonmetastatic castration-sensitive prostate cancer. We assessed how this aligns with current real-world treatment patterns. Descriptive analyses were performed on data abstracted from an independent, retrospective, cross-sectional survey, which collected information regarding treatment from urologists and radiation oncologists in the United States between April and November 2023 who were managing patients with high-risk biochemically recurrent nonmetastatic castration-sensitive prostate cancer. Data were derived from physician responses to questions regarding their perspectives on treatment and patient record forms for their last 6-10 patients with high-risk biochemical recurrence. Although the survey was retrospective in nature and not based on a true random sample of physicians and patients, the relatively minimal inclusion criteria used attempted to ensure a broad representation of physicians and patients with high-risk biochemically recurrent prostate cancer. An analysis cohort of 87 physicians submitted data for 535 eligible patients. Median time from diagnosis with high-risk biochemical recurrence to first-line treatment was 20 days. Median time between high-risk biochemical recurrence diagnosis and end of data collection was 286 days. The most common first-line treatments were androgen deprivation therapy alone (28%), radiation (20%), androgen receptor pathway inhibitor + androgen deprivation therapy (19%), and observation (13%). Among patients who received androgen deprivation therapy, 79% received it continuously. Adherence to treatment guidelines (cited by 49%) was the most common reason for physicians' first-line treatment choice. In our real-world analysis, patients with high-risk biochemically recurrent prostate cancer rapidly received first-line treatment after diagnosis. The top reason for treatment choice was adherence to guidelines. Our finding that patients with biochemical recurrence are promptly treated in the real world aligns with guidance suggesting clinical benefit of early intervention.