by Teresa C. Gallagher, Ph.D., MPH. CEO, Sparrow Search, “Connecting Patients with Clinical Trials.”
https://www.sparrowsearch.health
Bridging the Gap Between Proven Therapies and Real-World Care
When you first learn that prostate cancer has spread, the news can feel overwhelming for both patients and their loved ones. However, there is hopeful news for men diagnosed with metastatic castration-sensitive prostate cancer (mCSPC): it often responds well to hormone therapy, and adding additional treatments can significantly improve outcomes. This enhanced approach, known as Treatment Intensification (TI), is recommended by experts, yet surprisingly, many eligible patients still aren’t receiving it.
So, why are these crucial therapies being underutilized? And how can you or your loved ones ensure access to the best possible care?
What is Treatment Intensification (TI)?
Treatment Intensification involves adding additional powerful therapies to standard androgen deprivation therapy (ADT), also called hormone therapy. ADT works by reducing testosterone, which prostate cancer cells need to grow.
Among the significant advancements for metastatic prostate cancer treatment are androgen receptor pathway inhibitors (ARPIs), including medications like enzalutamide, apalutamide, abiraterone, and darolutamide. These drugs further block cancer growth signals, even when testosterone levels are already reduced.
For patients with aggressive or extensive disease, chemotherapy may also be added, sometimes alongside ARPIs, forming a robust and comprehensive approach.
Clinical studies consistently demonstrate that Treatment Intensification helps men with metastatic prostate cancer live longer, delays disease progression, and maintains a high quality of life.
What’s Happening in Real-World Treatment?
A recent study published in JAMA Network Open looked at how a random sample of American men with metastatic castration sensitive prostate cancer were treated between 2018 and 2022, based on an examination of their medical records. The results were eye-opening.
Out of more than 600 patients, only 30% received Treatment Intensification as their first line of therapy. The majority were treated with standard hormone therapy alone or with older medications that are not considered as effective today. Even when later treatments were factored in, just 57% of patients had ever received intensified care.
These numbers raise an important question: Why are so many patients missing out on a treatment approach that could help them live longer and maintain their quality of life?
Why Are Doctors Not Using TI?
For decades, prescribing Androgen Deprivation Therapy (ADT) alone was considered the “standard of care.” However, American and European clinical practice guidelines have evolved to uniformly recommend Treatment Intensification (TI) in patients with metastatic castration-sensitive prostate cancer.
Despite this shift, nearly 1 in 3 physicians still rely on the older standard, often because they haven’t kept up with the latest guidelines or may not be fully aware of them.
One of the most surprising findings from the study was how frequently doctors avoided TI due to concerns it might reduce a patient’s quality of life. In truth, the evidence shows the opposite: TI not only helps patients live longer but often maintains or even improves quality of life.
Comfort and well-being are top priorities for most physicians, which is reassuring. These treatments are generally well tolerated and concerns about side effects often come more from perception than actual clinical evidence.
Fewer than 5% of doctors cited insurance coverage as a barrier to prescribing TI. Most decisions were based on how doctors interpreted clinical factors like PSA levels, cancer aggressiveness, and disease spread.
Doctors who felt confident in the guidelines were more likely to recommend TI. Yet, many who believed they were following best practices still didn’t offer it. This inconsistency reflects a larger issue: uncertainty around applying the latest evidence.
How We Can Close the Gap Between Doctors and Patients?
1. Enhance Education for Doctors: Doctors want to help their patients make the best possible decisions. Some may hesitate to use Treatment Intensification because they aren’t fully familiar with the latest research. With better education on how well these treatments work and how manageable they are, more doctors can feel confident recommending them when they’re the right fit.
2. Simplify Clinical Guidelines: Guidelines are there to help, but they can sometimes feel complex or open to interpretation. Simplifying and clarifying how to use them in day-to day care could help more patients receive the treatments they truly need.
3.Encourage Patient Involvement: Patients should know all the options available to them. Doctors can help by explaining treatments in a simple and clear way. It also helps when they ask what matters most to the patient: whether that’s living longer, feeling better, or both. When doctors and patients make decisions together, care becomes more personal and more effective.
4.Define PSA Goals: PSA levels are an important part of prostate cancer care, but goals should be backed by the strongest data available. Establishing clear targets helps ensure treatments are working toward the outcomes that matter most.
What Can Patients and Families Do?
If you or someone you care about has prostate cancer, ask your doctor these important questions:
- Am I eligible for Treatment Intensification?
- What benefits and risks come with additional medications like ARPIs or chemotherapy?
- Are we following the latest guidelines for my treatment?
Being proactive and informed will help you to get the most effective treatment.
Reference: Physician Reasons for or Against Treatment Intensification in Patients With Metastatic Prostate Cancer. JAMA Network Open. 2024;7(12).
