Contemporary treatment standards and trends of systemic therapy in metastatic hormone-sensitive prostate cancer-implementing study data in clinical practice

Background: The treatment landscape of metastatic hormone-sensitive prostate cancer (mHSPC) has undergone fundamental changes in recent decades, moving away from the sole use of androgen deprivation therapy (ADT) and towards intensified combination therapies. Purpose: To what extent have the data from prospective phase III studies influenced clinical practice in the management of mHSPC over the past 5 or 10 years? Results: A total of 1098 mHSPC patients with a median age at metastasis of 70 years and a median prostate-specific antigen (PSA) level of 43 ng/ml were included in the present study. Significant differences were observed in terms of PSA nadirs in mHSPC after stratification by year of metastatic onset. Significant differences were also observed regarding systemic therapies applied in mHSPC and metastatic castration-resistant prostate cancer (mCRPC; p < 0.001). Regarding the annual estimated percentage change (EAPC) over the past 10 years, a significant decrease in ADT monotherapy from 85% (2013) to 29% (2023; EAPC: -12%, p < 0.001) was observed. Conversely, there was a significant increase in androgen receptor signaling inhibitor (ARSI) use from 6% in 2013 to 55% in 2023 (EAPC: +21.7%, p < 0.001). Regarding docetaxel chemotherapy, a bell-shaped pattern was apparent over the past 10 years, with rates increasing from 8% in 2013 to 25% in 2019 and decreasing to 0% in 2023. The proportion of triplet therapies was 16% in 2023. Conclusion: Over the past 10 years there has been an adaptation of intensified combination therapies for mHSPC in clinical reality, with the most frequent use of ARSI and triplet therapies.