Real-world management of advanced prostate cancer: A description of management practices of community-based physicians and prostate cancer specialists Academic Article uri icon

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abstract

  • Introduction The Canadian Genito-Urinary Research Consortium conducted a consensus development conference leading to 31 recommendations. We conducted a survey comparing community-based practice with the consensus recommendations on the management of metastatic castration sensitive prostate cancer (mCSPC), metastatic castration resistant prostate cancer (mCRPC) and non-metastatic castration resistant prostate cancer (nmCRPC). Methods An 87-item online questionnaire was sent to 600 community urologists and oncologists involved in the treatment of prostate cancer.  Results Based on the 72 responses received, a discordance of ­>25% was observed in 15 recommendations (48%). Of the academic physicians, 89% indicated treating with agents approved for non-metastatic castration resistant prostate cancer compared to 50% of community physicians (p=0.0005). Discrepancies were also observed for radiation to the prostate for low-volume metastatic castration sensitive prostate cancer which was 74% (academic) vs 27% (community), (p<0.0001); criteria for stopping therapy in metastatic castration sensitive prostate cancer in which 78% of academic physicians favored continuation of therapy in the event of PSA progression only, compared to 24% of community physicians. Sequencing of therapy after prior apalutamide for non-metastatic castration resistant prostate cancer using subsequent docetaxel treatment was observed in 81% of academic physicians vs 35% of community physicians, (p<0.0001), and use of genetic testing was favored by 74% of academics vs 36% of community physicians, (p<0.0001) for newly diagnosed metastatic prostate cancer.      Conclusions The areas of discordance between a national sample of community-based physicians and academic consensus recommendations represent potential areas for education, practice tools and future research.  

authors

  • Hotte, Sebastien
  • Finelli, Antonio
  • Chi, Kim N
  • Canil, Christina
  • Fleshner, Neil
  • Kapoor, Anil
  • Kolinsky, Michael
  • Malone, Shawn
  • Morash, Christopher
  • Niazi, Tamim
  • Noonan, Krista L
  • Ong, Michael
  • Pouliot, Frederic
  • Shayegan, Bobby
  • So, Alan I
  • Sorabji, Delna
  • Hew, Huong
  • Park-Wyllie, Laura
  • Saad, Fred

publication date

  • February 2021