AUA 2023: Treatment Trends in Patients With De Novo Metastatic Prostate Cancer in the Era of Upfront Combination Therapy

( The 2023 AUA annual meeting included an advanced prostate cancer session, featuring a presentation by Dr. Sasaki Daichi discussing treatment trends in patients with de novo metastatic prostate cancer in the era of upfront combination therapy. Given the variability in treatment of patients with metastatic hormone sensitive prostate cancer, Dr. Daichi and colleagues assessed trends in treatment selection for these patients.

This study was a multicenter, retrospective assessment of 595 patients in Japan treated with either upfront combination therapy (upfront novel hormonal therapies and taxane-based chemotherapy) or “vintage therapy” (androgen deprivation therapy with or without bicalutamide) between 2016 and 2021. High tumor burden metastatic disease was defined when a patient met the CHAARTED or LATITUDE criteria.1,2 This study specifically evaluated trends in treatment selection and reasons for selecting “vintage therapy.”

Of the 595 patients in this study, 123 and 472 patients were classified as having low and high tumor burden disease, respectively. Use of upfront combination therapy was found to be increasing, with utilization rates of 72% and 54% in 2021 for high and low tumor burden disease, respectively. Of the 163 patients who were offered upfront combination therapy, 74.2% selected “vintage therapy.” The breakdown of type of treatment stratified by university hospitals vs other hospitals was as follows:


university hospitals versus other.jpg

Reasons for selecting “vintage therapy:” included:

  • Refusal: 39.8%
  • Older age: 67.6%
  • Frailty: 56.3%
  • Comorbidity: 40.8%
  • Cost concerns: 16.9%

Dr. Daichi concluded this presentation discussing treatment trends in patients with de novo metastatic prostate cancer in the era of upfront combination therapy by highlighting that older age was the most common reason for declining upfront combination therapy.

Presented by: Sasaki Daichi, MD, Hirosaki University Graduate School of Medicine, Hirosaki, Japan

Written by: Zachary Klaassen, MD, MSc – Urologic Oncologist, Assistant Professor of Urology, Georgia Cancer Center, Augusta University/Medical College of Georgia, @zklaassen_md on Twitter during the 2023 American Urological Association (AUA) Annual Meeting, Chicago, IL, April 27 – May 1, 2023


  1. Sweeney CJ, Chen YH, Carducci M, et al. Chemohormonal Therapy in Metastatic Hormone-Sensitive Prostate Cancer. N Engl J Med. 2015;373(8):737-746.
  2. Fizazi K, Tran N, Fein L, et al. Abiraterone plus Prednisone in Metastatic, Castration-Sensitive Prostate Cancer. N Engl J Med. 2017;377(4):352-360.