e17038 Background: the management of metastatic castration-resistant prostate cancer (mCRPC) is increasingly complex, demanding greater multidisciplinary collaboration and reliance on advanced diagnostics. This study quantifies the real-world evolution of co-management, patient risk profiles, and diagnostic testing patterns between US academic and community settings. Methods: data were extracted from the Ipsos Global Oncology Monitor. We analyzed two consecutive 12-month cohorts of US mCRPC patients on active systemic therapy: 791 patients from Aug '23-Sep '24 and 645 from Aug '24-Sep '25. A year-over-year comparative analysis of patient characteristics, co-management rates, and diagnostic utilization was performed, stratifying by specialty (Oncology vs. Urology) and practice type (Academic vs. Community). Results: a significant trend towards multidisciplinary care was observed, with overall co-management increasing from 32% to 43% (p < 0.01). This growth was driven exclusively by the academic setting, which saw a threefold increase (18% to 64%; p < 0.01), while the community setting remained stable at 36%. This occurred even as community practices managed a higher-risk patient population, characterized by a dual burden of both more aggressive disease biology (67% vs. 48% with Gleason score 8-10; p < 0.01) and a greater prevalence of significant comorbidities (e.g., hypertension 70% vs. 41% p < 0.01; cardiovascular disease 25% vs. 15%; p < 0.01). Concurrently, the gap in PSMA-PET utilization between Oncologists/Heam Oncs (increasing from 60% to 80%) and Urologists (stationary at ~55-58%) widened significantly. This diagnostic disparity is also correlated with regimen choice, with Urologists favoring more often hormonal-only regimens linked to less frequent (quarterly) PSA testing. Conclusions: The mCRPC treatment landscape is rapidly consolidating around a co-management model, but this evolution is primarily confined to the academic setting, likely due to the infrastructure required for complex novel therapies. A concerning and widening gap in the adoption of PSMA-PET imaging persists, with urologists lagging significantly behind oncologists. This diagnostic disparity creates a critical barrier to care, as it may limit access to PSMA-targeted therapies for the higher-risk population predominantly managed in the community. These findings highlight an urgent need for educational and system-level changes to harmonize the application of advanced diagnostics and ensure equitable access to modern, evidence-based mCRPC care across all practice settings.
Franceschetti et al. (Thu,) studied this question.