OBJECTIVES: This study describes current treatment patterns, and demographic and clinical characteristics of mHSPC patients in the US.

METHODS: This cross-sectional, retrospective, chart review study included mHSPC patients (aged ≥ 18 years) in the US from the IPSOS Global Oncology Monitor Database (2018-2020) consisting of physician-provided data abstracted from patient charts. Descriptive analyses were conducted for all study objectives.

RESULTS: Among 3893 mHSPC patients, the majority received ADT monotherapy (53.9%) followed by first-generation androgen receptor inhibitor + ADT (13.7%) and abiraterone + ADT (13.7%) combination therapy. The use of docetaxel, including docetaxel alone, docetaxel with ADT, or with one or more non-ADT agents, was 6.1%. Percent utilizations for second-generation androgen receptor inhibitors (SGARI) and abiraterone, were 7.2% and 15.2% respectively. 99.85% of patients received monotherapy or combination therapy with 2 agents with only 0.15% receiving combination therapy with 3 agents.

Among the 2098 patients on ADT monotherapy, 73.2% were ≥70 years, 62.2% were white and 74.8% had Medicare. Additionally, 80.6% had an ECOG score of 0-1 and 53.5% had a Gleason score of 8-10, and 92.2% had at least one comorbidity (hypertension 66.7%, cardiovascular disease 32.4%, diabetes 26.5%, pulmonary disease 14.4%). Furthermore, 80.7% had boney metastatic disease while 43.3% reported bone pain.

CONCLUSIONS: mHSPC patients are still commonly treated with ADT monotherapy, despite painful bone metastases and competing comorbidities. This reveals underutilization of ADT combination therapy with docetaxel or with SGARI agents in mHSPC, despite clinical evidence and treatment guidelines showing improved survival with early treatment intensification. mHSPC patients present with different characteristics that may influence treatment options and outcomes. Treatment selection should thus account for patient comorbidities, notably cardiovascular disease or metabolic syndrome components when considering currently approved treatment regimens.