{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T02:28:41Z","timestamp":1790303321522,"version":"4.1.0"},"reference-count":38,"publisher":"Wiley","issue":"17","license":[{"start":{"date-parts":[[2025,9,3]],"date-time":"2025-09-03T00:00:00Z","timestamp":1756857600000},"content-version":"vor","delay-in-days":2,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cancer Medicine"],"published-print":{"date-parts":[[2025,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>This study evaluated treatment patterns and factors associated with androgen deprivation therapy (ADT) intensification with androgen receptor pathway inhibitors (ARPI) and\/or docetaxel among older men with mHSPC in the United States.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>The study utilized a retrospective cohort of 6850 older men (age\u2009\u2265\u200967\u2009years) diagnosed with mHSPC between July 2016 and December 2019 from the Surveillance, Epidemiology, and End Results Medicare\u2010linked database. Men must maintain continuous enrollment in Medicare fee\u2010for\u2010service Parts A\/B\/D for \u2265\u200912\u2009months before mHSPC diagnosis and \u2265\u20096\u2009months after diagnosis. Initial treatment was classified as ADT alone, ADT\u2009+\u2009ARPI, or ADT\u2009+\u2009docetaxel. Factors associated with initial treatment were examined using multivariable multinomial logistic regression.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The study cohort (mean age\u2009=\u200976.6\u2009years, SD\u2009=\u20097.0) was mostly non\u2010Hispanic white (77.7%), followed by non\u2010Hispanic Black (8.4%) and Hispanic (6.5%). 30.4% received no systemic drug therapy within 6 months of mHSPC diagnosis, 47.1% received ADT alone, 14.8% received ADT\u2009+\u2009ARPI, and 5.9% received ADT\u2009+\u2009docetaxel. Among men treated with ADT, there was an increase in ADT\u2009+\u2009ARPI treatment from 19.0% to 30.0% and a concomitant decline in ADT monotherapy from 72.1% to 62.6% between 2017 and 2019, while ADT\u2009+\u2009docetaxel treatment marginally decreased from 8.8% to 7.3%. In multinomial logistic regression, men with\n                      <jats:italic>de novo<\/jats:italic>\n                      mHSPC were more likely to receive ADT\u2009+\u2009docetaxel (aOR\u2009=\u20092.73, 95% CI\u2009=\u2009[2.07, 3.60]) or ADT\u2009+\u2009ARPI (aOR\u2009=\u20091.56, 95% CI\u2009=\u2009[1.32, 1.84]); whereas men with higher frailty index were less likely to receive ADT\u2009+\u2009docetaxel (aOR\u2009=\u20090.93, 95% CI\u2009=\u2009[0.91, 0.95]) or ADT\u2009+\u2009ARPI (aOR\u2009=\u20090.97, 95% CI\u2009=\u2009[0.96, 0.98]). Specifically, ADT\u2009+\u2009ARPI was less likely to be utilized among the lower socio\u2010economic status groups.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Three in 10 older men with mHSPC received no systemic treatment. Although there was a gradual uptake of ARPIs, monotherapy with ADT was still highly prevalent, suggesting the integration of intensified treatment is still suboptimal. Targeted interventions are necessary to enhance guideline adherence among older and frail men with mHSPC.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/cam4.71176","type":"journal-article","created":{"date-parts":[[2025,9,3]],"date-time":"2025-09-03T09:56:39Z","timestamp":1756893399000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Treatment Landscape for Older Men With Metastatic Hormone\u2010Sensitive Prostate Cancer in the United States"],"prefix":"10.1002","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9440-6295","authenticated-orcid":false,"given":"Bo","family":"Zhou","sequence":"first","affiliation":[{"name":"University of North Texas Health Science Center  Fort Worth Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amit D.","family":"Raval","sequence":"additional","affiliation":[{"name":"Bayer HealthCare Pharmaceuticals  Whippany New Jersey USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yifan","family":"Zhang","sequence":"additional","affiliation":[{"name":"University of North Texas Health Science Center  Fort Worth Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew J.","family":"Korn","sequence":"additional","affiliation":[{"name":"Bayer AG  Dexter Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nethra","family":"Sambamoorthi","sequence":"additional","affiliation":[{"name":"Bayer AG  Dexter Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rafia","family":"Rasu","sequence":"additional","affiliation":[{"name":"University of North Texas Health Science Center  Fort Worth Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Natasha","family":"Littleton","sequence":"additional","affiliation":[{"name":"Bayer Ltd  Dublin Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Niculae","family":"Constantinovici","sequence":"additional","affiliation":[{"name":"Bayer Consumer Care AG  Basel Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Usha","family":"Sambamoorthi","sequence":"additional","affiliation":[{"name":"University of North Texas Health Science Center  Fort Worth Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,9,3]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.3322\/caac.21763"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.3322\/caac.21731"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1093\/jnci\/djac158"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2022.2246"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1038\/pcan.2016.30"},{"issue":"37","key":"e_1_2_11_7_1","first-page":"622","article-title":"The Treatment of Metastatic, Hormone\u2010Sensitive Prostatic Carcinoma","volume":"119","author":"Merseburger A. 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