Results from a new sub-analysis of the IMPLEMENT study have uncovered significant differences in how academic and non-academic physicians approach treatment intensification for metastatic castration-sensitive prostate cancer (mCSPC), highlighting a concerning gap in adoption of newer therapeutic options.
Dr. Neeraj Agarwal, medical oncologist and director of the Genitourinary Oncology Program at Huntsman Cancer Institute, presented these findings at the 2025 ASCO Genitourinary Cancers Symposium, revealing distinct patterns between high-intensity and low-intensity prescribers.
Key Differences in Treatment Approaches
The two-phase study identified several critical barriers and facilitators affecting treatment decisions. Non-academic physicians and those classified as low-intensity prescribers more frequently reported obstacles such as:
- Knowledge gaps about newer treatment options
- Concerns about potential side effects
- Limited familiarity with recent therapeutic advances
In contrast, academic physicians and high-intensity prescribers demonstrated different motivating factors:
- Strong emphasis on clinical support systems
- Focus on documented survival benefits
- Greater confidence in managing newer treatment modalities
Impact on Patient Care
The findings suggest that some patients may not be receiving optimal treatment intensification based on their treating physician's practice setting. Dr. Agarwal noted that some physicians continue to rely on older treatment combinations, such as ADT plus bicalutamide, instead of adopting newer second-generation ARPIs with or without chemotherapy.
"There is a clear difference between the barriers faced by high intensifiers versus low intensifiers," Dr. Agarwal explained. "An approach to solve this problem is going to be physician-specific or practice-specific."
Bridging the Treatment Gap
Dr. Agarwal emphasized the crucial role patients can play in bridging this treatment gap. He encourages patients to actively engage with their healthcare providers about available treatment options, particularly regarding developments from the past five to six years.
"Unless they ask, they were not going to make them think so," Dr. Agarwal stated, suggesting that patient inquiries could motivate physicians to review and consider newer treatment options. This patient-driven approach could lead to more informed discussions during follow-up visits, potentially improving access to optimal treatment strategies.
Path Forward
The study's findings underscore the need for targeted educational initiatives and support systems for community-based physicians. Addressing these disparities in treatment adoption could help ensure that all mCSPC patients have access to the most appropriate and effective therapeutic options, regardless of their treatment setting.
