BACKGROUND: Prostate cancer has a multifaceted treatment pattern. Evidence is lacking for optimal treatment sequences for metastatic castration-resistant prostate cancer (mCRPC). OBJECTIVE: To increase the understanding of real-world treatment pathways and outcomes in patients with mCRPC. DESIGN SETTING AND PARTICIPANTS: A prospective, noninterventional, real-world analysis of 3003 patients with mCRPC in the Prostate Cancer Registry (PCR; NCT02236637) from June 14, 2013 to July 9, 2018 was conducted. INTERVENTION: Patients received first- and second-line hormonal treatment and chemotherapy as follows: abiraterone acetate plus prednisone (abiraterone)-docetaxel (ABI-DOCE), abiraterone-enzalutamide (ABI-ENZA), abiraterone-radium-223 (ABI-RAD), docetaxel-abiraterone (DOCE-ABI), docetaxel-cabazitaxel (DOCE-CABA), docetaxel-enzalutamide (DOCE-ENZA), and enzalutamide-docetaxel (ENZA-DOCE). OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Baseline patient characteristics, quality of life, mCRPC treatments, and efficacy outcomes (progression and survival) were presented descriptively. RESULTS AND LIMITATIONS: Data from 727 patients were eligible for the analysis (ABI-DOCE n = 178, ABI-ENZA n = 99, ABI-RAD n = 27, DOCE-ABI n = 191, DOCE-CABA n = 74, DOCE-ENZA n = 116, and ENZA-DOCE n = 42). Demographics and disease characteristics among patients between different sequences varied greatly. Most patients who started on abiraterone or enzalutamide stopped therapy because of disease progression. No randomisation to allow treatment/sequence comparisons limited this observational study. CONCLUSIONS: The real-world PCR data complement clinical trial data, reflecting more highly selected patient populations than seen in routine clinical practice. Baseline characteristics play a role in mCRPC first-line treatment selection, but other factors, such as treatment availability, have an impact. Efficacy observations are limited and should be interpreted with caution. PATIENT SUMMARY: Baseline characteristics appear to have a role in the first-line treatment selection of metastatic castration-resistant prostate cancer in the real-world setting. First-line abiraterone acetate plus prednisone seems to be the preferred treatment option for older patients and those with lower Gleason scores, first-line docetaxel for younger patients and those with more advanced disease, and first-line enzalutamide for patients with fewer metastases and more favourable performance status. The benefit to patients from these observations remains unknown.

AZ Groeninge Kortrijk Belgium

Centrum Onkologii im Prof F Lukaszczyka w Bydgoszczy Dzial Onkologii Klinicznej Ambulatorium Chemioterapii Bydgoszcz Poland

Department of Surgical and Perioperative Sciences Urology and Andrology Umeå University Umeå Sweden

Department of Urology Medical University of Vienna Vienna Austria

Department of Urology Skåne University Hospital Lund University Malmö Sweden

Faculdade de Medicina da Universidade de Lisboa Lisbon Portugal

Guy's and St Thomas' NHS Foundation Trust and Sarah Cannon Research Institute London UK

Helios Klinikum Bad Saarow Bad Saarow Germany

Hospital Clínico Universitario de Santiago Servicio de Urología Santiago de Compostela Spain

Institut Mutualiste Montsouris Paris France

Instituto de Medicina Molecular João Lobo Antunes Lisbon Portugal

Janssen Cilag BV Breda The Netherlands

Janssen Cilag High Wycombe UK

Oncology Division Centro Hospitalar Universitário Lisboa Norte Lisbon Portugal

Parexel International Czech Republic sro on behalf of Janssen Pharmaceutica NV Beerse Belgium

Pisana University Hospital Pisa Italy

Rambam Medical Center Haifa Israel

Royal Blackburn Hospital Blackburn UK

Trakya University Hospital Medical Oncology Department Edirne Turkey

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