(UroToday.com) The 2026 American Society of Clinical Oncology Genitourinary (ASCO) Annual Meeting, held in Chicago, IL, will host the Prostate, Testicular, and Penile Cancer – Posters Session. Dr. Manojkumar Bupathi will present Abstract 5080: Real-world characteristics, HRR mutation testing, treatment patterns, and outcomes of patients with metastatic castration sensitive prostate cancer (mCSPC) in the US community oncology setting.
Homologous recombination repair mutation (HRRm) testing is now recommended by NCCN guidelines for patients with metastatic castration-sensitive prostate cancer. While prior studies, such as CAPTURE, suggested that HRRm carriers may experience worse outcomes, real-world data evaluating the prognostic significance of HRRm in mCSPC, particularly within US community oncology practices, remain limited.
This retrospective observational cohort study evaluated patients with documented HRRm testing who initiated systemic therapy for mCSPC between January 2019 and March 2024 across the US Oncology Network and affiliated non-network practices. Stratified random samples of 150 patients with HRRm and 150 without HRRm were selected for detailed chart abstraction.
The investigators evaluated somatic and germline alterations across a 12-gene HRRm panel, including ATM, ATR, BRCA1/2, CDK12, CHEK2, FANCA, MLH1, MRE11A, NBN, PALB2, and RAD51C. Clinical outcomes included overall survival (OS) and real-world progression-free survival (rwPFS), analyzed according to HRRm status, de novo metastatic presentation, and high-volume disease (HVD).
Overall, 300 patients were included, with a median age of 69 years and a median follow-up of 25 months. Among HRRm-positive patients, 47% harbored BRCA mutations while 53% had non-BRCA HRRm alterations. De novo metastatic disease was identified in 65% of HRRm patients and 67% of non-HRRm patients, while high-volume disease was present in 57% and 64%, respectively.
Frontline treatment approaches were generally balanced between groups, including ADT alone, ADT plus ARPI, ADT plus docetaxel, and triplet therapy combinations.
Patients with HRRm mCSPC experienced numerically shorter survival outcomes across several clinical subgroups compared with patients without HRRm alterations. In the overall population, median OS was 44.0 months in the HRRm cohort versus 48.5 months in the non-HRRm cohort, while median rwPFS was 17.5 versus 22.6 months, respectively.
Among patients with de novo metastatic disease:
- Median OS was 41.7 months in HRRm patients versus 48.5 months in non-HRRm patients
- Median rwPFS was 15.4 versus 22.0 months, respectively
In patients with high-volume disease:
- Median OS was 44.4 months in HRRm patients versus 42.5 months in non-HRRm patients
- Median rwPFS was 17.7 versus 19.2 months, respectively
Key Messages:
- Patients with HRRm mCSPC experienced numerically shorter OS and rwPFS compared with non-HRRm patients in this real-world cohort
- Outcomes appeared particularly worse among patients presenting with de novo metastatic disease
- Nearly half of HRRm-positive patients harbored BRCA alterations, while the remainder carried non-BRCA HRRm mutations
- These findings further support the importance of early HRRm testing in mCSPC
- Earlier integration of targeted therapeutic strategies may help improve outcomes for this higher-risk patient population
Presented by: Manojkumar Bupathi, MD, MS, Medical Oncologist, Rocky Mountain Cancer Centers, Littleton, CO
Written by: Julian Chavarriaga, MD, Clinical Assistant Professor, Urologic Oncologist, Department of Urology at Penn State Health @chavarriagaj on X during the American Society of Clinical Oncology Genitourinary (ASCO) Annual Meeting held in Chicago, IL between May 29th and June 1st, 2026