OBJECTIVES: To describe the metastatic castration-resistant prostate cancer (mCRPC) treatment landscape and sequencing – including metastatic hormone-sensitive prostate cancer (mHSPC) to first-line (1L) mCRPC.

METHODS: Data were drawn from the Adelphi Real World Prostate Cancer (PC) Disease Specific Programme™, a cross-sectional survey with retrospective data collection of physicians and their patients in France, Germany, Italy, Spain, and the United Kingdom from November 2022 – May 2023. Physicians completed patient record forms for eight consecutively consulting patients with mCRPC, reporting demographics, clinical characteristics, and treatment patterns. Patients with PC as their only malignancy were included. Analyses were descriptive. NHA/chemotherapy refers to monotherapy usage (± androgen deprivation therapy [ADT]).

RESULTS: Overall, 221 physicians (84% medical oncologists, 16% urologists) reported on 1737 patients. At data collection, median (interquartile range; IQR) age was 73.0 (68.0–78.0) years, 46% had high-volume disease, and 77% had an ECOG score 0–1. Initial diagnosis was localized disease (50%) and median (IQR) time since mCRPC diagnosis was 159.2 (79.0–359.2) days.

At 1L (n=1737), 60% of patients received an NHA. At second-line (2L) (n=301) 42% received chemotherapy and 35% received NHA. At third-line (3L) (n=41), 46% received chemotherapy. Most common 1L to 2L sequence was NHA to chemotherapy (35%); whilst 16% received chemotherapy to NHA. Most common 2L to 3L sequence was NHA to chemotherapy (27%).

For patients with mHSPC treatment history (n=1194), 29% received ADT alone for treatment at mHSPC then NHA at 1L mCRPC. For patients who received NHA in the mHSPC setting (n=291), 60% received chemotherapy at 1L mCRPC and 21% were rechallenged with NHA.

CONCLUSIONS: This real-world analysis shows that NHA usage frequently occurs prior to chemotherapy use in the mCRPC setting. However, the majority of patients are NHA naïve at mCRPC diagnosis despite guideline recommendations for NHA usage at the mHSPC setting.