{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T08:06:00Z","timestamp":1787731560561,"version":"build-2784847793"},"reference-count":31,"publisher":"American Medical Association (AMA)","issue":"10","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"Importance<\/jats:title>Despite evidence of clinical benefits and guidelines recommending first-line treatment intensification (TI) for metastatic castration-sensitive prostate cancer (mCSPC), the majority of patients do not receive it.<\/jats:p><\/jats:sec>Objective<\/jats:title>To identify barriers to and facilitators of first-line TI.<\/jats:p><\/jats:sec>Design, Setting, and Participants<\/jats:title>The IMPLEMENT study (December 2022 to August 2024) comprised 3 phases and used a mixed-methods, qualitative and quantitative approach. US-based urologists and oncologists who were primary treaters for 1 or more patients with mCSPC in the past 6 months, had been practicing for 2 to 35 years, spent 50% or more of their time in direct patient care, and were able to provide informed consent were included.<\/jats:p><\/jats:sec>Exposure<\/jats:title>Phase 1 consisted of semistructured interviews based on the Theoretical Domains Framework. Phase 2 consisted of a discrete choice experiment to identify priority barriers and helpful resources. Phase 3 consisted of cocreation sessions to ideate potential solutions to underutilization based on the findings of the previous phases.<\/jats:p><\/jats:sec>Main Outcomes and Measures<\/jats:title>The primary outcome in phase 1 was barriers to and facilitators of first-line TI, as identified through thematic analysis. The primary outcome of phase 2 was perceived helpfulness of potential resources for first-line TI decisions, measured with a coefficient of helpfulness [CoH] for each resource. The primary outcome of phase 3 was potential solutions to increase TI uptake, as cocreated and ranked by urologists and oncologists.<\/jats:p><\/jats:sec>Results<\/jats:title>In total, 352 participants were included in IMPLEMENT, with 36 in phase 1 (33 men [92%]; mean [range] years in practice, 19 [5-34]), 302 in phase 2 (253 men [84%]; mean [range] years in practice, 18 [4-35]), and 14 in phase 3 (12 men [86%]; mean [range], years in practice, 20 [8-35]). In each phase, one-half of participants were oncologists and one-half were urologists (18 urologists and 18 oncologists in phase 1, 151 urologists and 151 oncologists in phase 2, and 7 urologists and 7 oncologists in phase 3). In phase 1, 5 domains had the greatest perceived influence on intensification: memory, attention, and decision processes; environmental context and resources; knowledge; beliefs about consequences; and social or professional role. Urologists more commonly reported barriers to intensification, while oncologists more commonly reported facilitators. In phase 2, urologists found decision-support tools most helpful (CoH, 3.27; 95% CI, 2.90-3.65), while oncologists preferred databases of posttreatment options (CoH, 2.58; 95% CI, 2.29-2.89) and clinical trial summaries (CoH, 2.41; 95% CI, 2.14-2.69). In phase 3, cross-specialty tumor boards were ranked by both specialties as the best solution to address TI underutilization.<\/jats:p><\/jats:sec>Conclusions and Relevance<\/jats:title>This study using a mixed-methods approach with quantitative and qualitative components found that the issues underlying TI underutilization were numerous and multifactorial; the barriers encountered by physicians and the resources to help address them varied by specialty. These findings offer insights into physician-supported strategies that could help improve rates of first-line TI for mCSPC in the US.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2025.35728","type":"journal-article","created":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T15:00:24Z","timestamp":1760022024000},"page":"e2535728","source":"Crossref","is-referenced-by-count":4,"title":["Barriers and Facilitators of Treatment Intensification in Metastatic Castration-Sensitive Prostate Cancer"],"prefix":"10.1001","volume":"8","author":[{"given":"Stacy","family":"Loeb","sequence":"first","affiliation":[{"name":"Department of Urology, New York University Langone Health, New York City"},{"name":"Department of Population Health, New York University Langone Health, New York City"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Neeraj","family":"Agarwal","sequence":"additional","affiliation":[{"name":"Huntsman Cancer Institute, University of Utah, Salt Lake City"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nader","family":"El-Chaar","sequence":"additional","affiliation":[{"name":"Astellas Pharma Inc, Northbrook, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"de Ruiter","sequence":"additional","affiliation":[{"name":"Astellas Pharma Inc, Northbrook, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Janet","family":"Kim","sequence":"additional","affiliation":[{"name":"Astellas Pharma Inc, Northbrook, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jesse","family":"Mack","sequence":"additional","affiliation":[{"name":"Astellas Pharma Inc, Northbrook, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Betty","family":"Thompson","sequence":"additional","affiliation":[{"name":"Pfizer Inc, New York City, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah","family":"Rich-Zendel","sequence":"additional","affiliation":[{"name":"Throughline Strategy, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jay","family":"Sheldon","sequence":"additional","affiliation":[{"name":"Throughline Strategy, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jin Su","family":"Joo","sequence":"additional","affiliation":[{"name":"Throughline Strategy, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Judith","family":"Dyson","sequence":"additional","affiliation":[{"name":"Birmingham City University, Birmingham, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","published-online":{"date-parts":[[2025,10,9]]},"reference":[{"issue":"6","key":"zoi250998r1","doi-asserted-by":"publisher","first-page":"1082","DOI":"10.1097\/JU.0000000000003452","article-title":"Updates to advanced prostate cancer: AUA\/SUO Guideline (2023).","volume":"209","author":"Lowrance","year":"2023","journal-title":"J Urol"},{"issue":"2","key":"zoi250998r3","doi-asserted-by":"publisher","first-page":"101","DOI":"10.1016\/j.eururo.2024.10.017","article-title":"What\u2019s in a name? 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