The Role of Physician Specialty in the Underutilization of Standard-of-Care Treatment Intensification in Patients with Metastatic Castration-Sensitive Prostate Cancer.

To evaluate utilization of treatment intensification (TI) of androgen deprivation therapy (ADT) with androgen receptor pathway inhibitor (ARPI)/docetaxel for metastatic castration-sensitive prostate cancer (mCSPC) patients across physician specialties.

This retrospective study identified patients with mCSPC in the Optum Research Database between 2014 and 2019. Adult men with ≥1 claim for metastatic disease within 90 days before or any time after the first prostate cancer claim who received ADT were included. Physician specialty, determined from medical/pharmacy claims during each line of therapy (LOT), was categorized as urologist only, oncologist only, both (urologists and oncologists), or other (other specialties). TI and patient characteristics were analyzed descriptively.

Of 4,675 patients, 16% were treated by urologists only, 20% by oncologists only, 63% by both, and 1.1% by others. Most frequent first LOT was ADT ± first-generation nonsteroidal antiandrogens (>50%). ADT + docetaxel use declined over time, while ADT + ARPI increased. Patients seen by oncologists or both were younger, had fewer comorbidities and were likelier to receive TI compared to those treated by urologists. By 2019, however, TI remained <40% from oncologists only or both and <15% from urologists only. In the second and third LOTs, ADT + ARPI was the most prescribed regimen across specialties (>50%).

TI was underused in first LOTs across urology and oncology specialties despite evidence of improved survival. In subsequent lines, ADT + ARPI was prescribed more frequently across specialties. These results underscore the need for earlier TI by urologists and oncologists.

The Journal of urology. 2023 Feb 15 [Epub ahead of print]

Umang Swami, Agnes Hong, Nader N El-Chaar, Krishnan Ramaswamy, Brandon J Diessner, Cori J Blauer-Peterson, Rickard Sandin, David Nimke, Neeraj Agarwal

Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah., Astellas Pharma Inc., Northbrook, Illinois., Pfizer Inc., New York, New York., Optum, Eden Prairie, Minnesota., Pfizer AB, Sollentuna, Sweden.