OBJECTIVES: International prostate cancer treatment guidelines recommend combination therapy regimens as standard of care for mHSPC. This study evaluated global real-world mHSPC treatment patterns, concordance with treatment guidelines, and patient characteristics.

METHODS: This retrospective cohort study included mHSPC patients (aged ≥18 years) from the US, Germany, France, Japan, and China within the IPSOS Global Oncology Monitor Database (2018-2020). Treatment patterns were described as proportions of patients receiving each regimen at time of data capture.

RESULTS: The study included 6,198 mHSPC patients (US 3,893, Germany 867, France 513, Japan 641, and China 284). Among monotherapies, androgen deprivation therapy (ADT) was most frequently prescribed (20.3%-58.1%) in each country except China where first-generation androgen receptor inhibitors (FGARI) were most common. Top combination therapies were FGARI + ADT (67.2% in Japan, 54.6% in China, and 13.7% in the US); abiraterone + ADT (17.9% in France); and docetaxel + ADT (11.2% in Germany). Combination therapies with more than two agents were <1.0%.

Compared to patients receiving non-docetaxel combinations (ADT + second-generation androgen receptor inhibitors (SGARI) or FGARI or abiraterone), docetaxel + ADT patients were younger (aged ≥ 70 years: 37.9% vs 68.8%), had more advanced disease (Gleason score 8-10: 78.0% vs. 60.6%, bone metastasis: 96.6% vs. 78.6%), but were better functioning (ECOG score 0-1: 92.4% vs. 85.4%). Top comorbidities were hypertension (58.7% vs. 55.9%), cardiovascular disease (20.1% vs. 24.4%), and diabetes (16.3% vs. 24.4%) for the respective populations.

CONCLUSIONS: Among a global sample of mHSPC patients, the most common treatment was ADT monotherapy despite guidelines recommending early treatment intensification with addition of either novel anti-androgens or docetaxel. Docetaxel + ADT continues to be an important standard of care. These findings highlight the discrepancy between guideline-recommended and recent real-world treatment patterns for mHSPC and the need for early treatment intensification to improve patient outcomes.