Disease characteries, treatment patterns, and oncological outcomes of de novo metastatic hormone-sensitive prostate cancer: real-world experience from a multicenter Asian cohort

This multicenter retrospective study assessed real-world treatment patterns and outcomes in de novo metastatic hormone-sensitive prostate cancer (mHSPC) across five urological centers in Hong Kong (China; from 2016 to 2023). Of 3308 patients, 814 (24.6%) presented with de novo mHSPC. High-volume and high-risk disease were present in 59.1% and 53.8% of patients, respectively. Despite guidelines favoring intensified therapy, androgen deprivation therapy (ADT) monotherapy remained the most common treatment (52.0%), while only 28.7% received upfront chemotherapy (20.5%) or androgen receptor pathway inhibitors (ARPI; 8.2%). During a median 40-month follow-up period, 48.4% of patients died and 60.1% progressed to castration-resistant prostate cancer (CRPC) within a median of 19 months. Five-year overall survival rates were highest for ARPI (64.9%), followed by chemotherapy (53.5%) and monotherapy (38.7%), with corresponding 5-year CRPC-free survival rates of 73.5%, 7.7%, and 15.0%, respectively. Upfront chemotherapy and ARPI demonstrated significant reductions in cancer-specific mortality compared to ADT monotherapy (chemotherapy hazard ratio [HR]: 0.58, 95% confidence interval [CI]: 0.41-0.82, P = 0.002; ARPI HR: 0.32, 95% CI: 0.17-0.62, P < 0.001). High-volume disease (HR: 2.14, 95% CI: 1.52-3.01, P < 0.001) and ISUP Grade 4 or 5 (HR: 5.70, 95% CI: 1.82-17.87, P = 0.003) conferred increased risk. Upfront chemotherapy and ARPI were independently associated with improved overall survival (chemotherapy HR: 0.56, 95% CI: 0.41-0.78, P < 0.001; ARPI HR: 0.41, 95% CI: 0.24-0.69, P < 0.001). High-volume mHSPC (HR: 1.65, 95% CI: 1.24-2.21, P < 0.001) and ISUP Grade 4 or 5 (HR: 2.38, 95% CI: 1.22-4.65, P = 0.011) were significant adverse prognostic factors. Advanced age at diagnosis was associated with increased all-cause mortality (HR: 1.02, 95% CI: 1.00-1.03, P = 0.037). These findings highlight an urgent need to improve adoption of intensified treatment strategies for optimal patient outcomes.