Improving Treatment for Metastatic Prostate Cancer: Addressing Barriers to Intensification
Despite strong evidence demonstrating its benefits, many patients with metastatic castration-sensitive prostate cancer (mCSPC), also known as metastatic hormone-sensitive prostate cancer, are not receiving recommended first-line treatment intensification.The IMPLEMENT study investigated the reasons behind this underutilization, exploring how clinicians’ behaviors, beliefs, and work environments impact their decisions. This research combined qualitative and quantitative methods to understand the perspectives of both urologists and oncologists.
Key Barriers to Optimal Care
The study revealed a complex interplay of factors hindering treatment intensification. These included gaps in knowledge, a lack of adequate clinical support, and challenges in the decision-making process. Physicians’ psychological considerations also played a important role; those anticipating regret from not maximizing survival were more inclined to intensify treatment, while concerns about side effects and quality of life led to more cautious approaches.
Notably,differences emerged between specialties. Oncologists generally reported greater access to resources and a stronger focus on maximizing survival. In contrast, urologists were more influenced by established routines, limited resources, and a lower level of confidence in intensifying therapy.
A Collaborative Path Forward
To address these challenges, the final phase of the IMPLEMENT study focused on developing practical solutions. The most promising approach identified was the implementation of cross-specialty tumor boards, fostering collaboration and communication between urologists and oncologists. Specifically,virtual tumor boards – offering accessibility for community physicians and continuing education credits – were highlighted as a particularly effective strategy.
By tackling educational gaps, behavioral influences, and structural limitations, this collaborative approach aims to align clinical practice with evidence-based guidelines. Ultimately, encouraging knowledge sharing, robust decision support, and interdisciplinary teamwork can improve outcomes and ensure more patients with mCSPC receive the optimal treatment intensification they deserve.
Reference:
Loeb S et al.Barriers and facilitators of treatment intensification in metastatic castration-sensitive prostate cancer. JAMA Netw Open. 2025;8(10):e2535728.
