Abstract Purpose We aimed to describe treatment patterns of patients with nonmetastatic castration-resistant prostate cancer (nmCRPC) who progressed after receiving darolutamide in a real-world setting, and according to the standard clinical practice in Spain. Methods This was a multicenter, observational, retrospective study conducted at the urology and oncology departments of 17 Spanish hospitals that participated in the ARAMIS trial and its rollover study. Results 85 patients, with a median age of 76 years, were included in the study. 49 patients (57.6%) progressed to mCRPC, with metastases located mainly in bone. Only 35 of them (71.4%) received at least one subsequent therapy. The most common first-line treatments after darolutamide were abiraterone ( n = 22, 63%) and docetaxel ( n = 10, 29%), with a median (IQR) treatment duration of 7.6 months (4.7, 12.7) and 4.8 months (3.8, 5.8), respectively; besides, the most frequent first-line/second-line treatment sequences were abiraterone–docetaxel and docetaxel–cabazitaxel. In addition, only 20% of patients with bone metastases received osteoclast-targeted therapy. Conclusion These real-world practice patterns suggest a lack of consensus in Spanish clinical practice for the management of patients with mCRPC, indicating that there is a need for more standardized strategies and unification of the criteria to make decisions in accordance with the recommendations of international clinical practice guidelines. Clinical trial registration Not applicable.
Puente et al. (2026) studied this question.