Recent treatment patterns in US-based real-world patients (pts) with metastatic hormone-sensitive prostate cancer (mHSPC).
Authors: Swami Umang , Jo Yeonjung , Ozay Zeynep Irem , Hage Chehade Chadi , Gebrael Georges , Sayegh Nicolas , Ostrowski Micah , Anderson Ethan , Garg Diya , Srivastava Ayana , Chigarira Beverly , HU Siqi , Mathew Thomas Vinay , Gupta Sumati , Maughan Benjamin L. , Guha Avirup , Riaz Irbaz Bin , Roy Soumyajit , Agarwal Neeraj 
Published: February 2025

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Background:
Androgen deprivation therapy (ADT) intensification [ADT + androgen receptor-pathway inhibitor (ARPIs) +/- docetaxel] has been shown to improve survival outcomes in pts with mHSPC and is recommended as standard of care by all major guidelines. However, prior studies have shown underutilization of ADT intensification [PMID: 39191549]. There are limited updated and large-scale studies on the use of ADT intensification, beyond January 2023. In this study, we aimed to assess the treatment patterns of ADT intensification in real-world pts with mHSPC in the US, including data on those treated since January 2023.
Methods:
This retrospective study utilized the nationwide Flatiron Health Electronic Health Record (EHR) derived de-identified database. Eligibility: Pts diagnosed with mHSPC and availability of treatment information (ADT and/or line of therapy in mHSPC). The data cut-off date was 5/31/2024. Treatment patterns were summarized using frequency and percentages. All analysis was done using R version 4.2.3.
Results:
Among 24,105 pts with metastatic prostate cancer in the database, a total of 14,084 were eligible and included. The median age at metastatic diagnosis was 72 years (IQR 65 – 79), and 60% were White non-Hispanic. In the overall cohort (1/1/2013–5/15/2024), 56.8% received ADT monotherapy, and 37.7% received ADT intensification. Table summarizes the treatment patterns by year, highlightinga consistent increase in adoption of intensified ADT regimens, and a decline in use of ADT monotherapy. Notably, since January 2023, 76.8% pts with mHSPC received ADT intensification while only 17.3% of pts received ADT monotherapy.
Conclusions:
To our knowledge, this is the first and largest study to evaluate the current use of ADT intensification. These data indicate a notable improvement in the adoption of level 1 evidence (ADT intensification) in the treatment of pts with mHSPC. These encouraging data emphasize the benefits of continued efforts to promote guideline-concordant care and provide the current treatment landscape to design clinical trials.

Treatment patterns by year in pts with mHSPC.

Treatment
2013–2017n = 5,263(%)
2018n = 1,313 (%)
2019n = 1,407(%)
2020n = 1,353(%)
2021n = 1,483(%)
2022n = 1,556(%)
2023n = 1,459(%)
2024n = 250(%)

ADT monotherapy
4,095 (77.8)
856 (65.2)
819 (58.2)
664 (49)
698 (47.1)
569 (36.6)
291 (20)
5 (2)

ADT + ARPI
155 (2.9)
238 (18)
354 (25.1)
452 (33)
555 (37.4)
695 (44.7)
842 (58)
154 (61.6)

ADT + Docetaxel
709 (13.5)
156 (12)
175 (12.4)
156 (12)
134 (9.0)
117 (7.5)
78 (5.3)
19 (7.6)

Triplet(ADT + ARPI + Docetaxel)
6 (0.1)
2 (0.2)
1 (0.1)
2 (0.1)
9 (0.6)
82 (5.2)
166 (11.1)
53 (21.2)

Other therapies
298 (5.7)
61 (4.6)
58 (4.1)
79 (5.8)
87 (5.9)
93 (6)
82 (5.6)
19 (7.6)