{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T22:06:23Z","timestamp":1789423583389,"version":"build-2803163510"},"reference-count":21,"publisher":"American Society of Clinical Oncology (ASCO)","issue":"9","content-domain":{"domain":["ascopubs.org"],"crossmark-restriction":true},"short-container-title":["JCO Oncol Pract"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:sec>\n                    <jats:title>PURPOSE<\/jats:title>\n                    <jats:p>Oncology clinical practice guidelines recommend bone-modifying agents (BMAs) to decrease skeletal-related events for patients with metastatic castration-resistant prostate cancer (mCRPC) and against BMAs to decrease skeletal-related events in metastatic castration-sensitive prostate cancer (mCSPC). Previous studies have identified gaps in guideline-concordant BMA use, but interprovider variation is poorly understood.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>We conducted a multicenter, retrospective, cohort study of patients diagnosed with prostate cancer and bone metastases during 2020-2021. The sample included three health systems in the Northeastern United States: two community-based networks and one academic cancer center. Patient characteristics and BMA use (zoledronic acid and denosumab) were ascertained via chart review. The outcomes of interest were BMA overuse during castration-sensitive prostate cancer (CSPC; defined as BMA initiation before emergence of castration-resistant prostate cancer [CRPC], among patients without a comorbid condition for which BMA therapy may be appropriate: osteoporosis, osteopenia, or osteoporotic fracture) and appropriate use during CRPC (BMA initiation after emergence of CRPC).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>There were 153 eligible patients, 51 from each health system. At diagnosis, 14 (9%) patients had documented osteoporosis or osteopenia, 22 (14%) had previous osteoporotic fracture, and 36 (24%) had chronic renal insufficiency. Among 95 patients assessable for overuse during CSPC, 16% (n = 17) received BMA (ranging from 13% to 21% among the three systems). Among 55 patients who developed CRPC, 44% (n = 24) had initiated BMA therapy as of most recent follow-up. There was greater variation in use during CRPC, ranging from 22% to 54% across the three systems.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSION<\/jats:title>\n                    <jats:p>BMA overuse in mCSPC was rare, potentially reflecting de-implementation following evidence of lack of benefit. Appropriate BMA use for patients with mCRPC varies substantially among clinicians and health care systems. Interventions to increase guideline-concordant care may improve outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1200\/op-25-00457","type":"journal-article","created":{"date-parts":[[2025,11,3]],"date-time":"2025-11-03T20:59:29Z","timestamp":1762203569000},"page":"1599-1607","update-policy":"https:\/\/doi.org\/10.1200\/crossmark","source":"Crossref","is-referenced-by-count":0,"title":["Interprovider Variation in Initiation of Bone-Modifying Agents for Patients With Prostate Cancer"],"prefix":"10.1200","volume":"22","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3639-3515","authenticated-orcid":true,"given":"Aaron P.","family":"Mitchell","sequence":"first","affiliation":[{"name":"Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY"},{"name":"Genitourinary Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY"},{"name":"Department of Medicine, Weill Cornell Medicine, New York, NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3145-2953","authenticated-orcid":true,"given":"Andrew","family":"Salner","sequence":"additional","affiliation":[{"name":"Hartford HealthCare Cancer Institute, Hartford, CT"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Palyca","sequence":"additional","affiliation":[{"name":"Lehigh Valley Health Network, Lehigh Valley Topper Cancer Institute, Allentown, PA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Azeez","family":"Farooki","sequence":"additional","affiliation":[{"name":"Endocrinology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-5666-7994","authenticated-orcid":true,"given":"Sonia","family":"Persaud","sequence":"additional","affiliation":[{"name":"Department of Health Policy and Management, University of Pittsburgh School of Public Health, Pittsburgh, PA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-8104-4311","authenticated-orcid":true,"given":"Nirjhar","family":"Chakraborty","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-6604-9053","authenticated-orcid":true,"given":"Dedipya","family":"Bhamidipati","sequence":"additional","affiliation":[{"name":"State University of New York Downstate Health Sciences University, New York, NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-8821-2741","authenticated-orcid":true,"given":"Maria","family":"Klimchuk","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New 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NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9454-0096","authenticated-orcid":true,"given":"Michael J.","family":"Morris","sequence":"additional","affiliation":[{"name":"Genitourinary Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY"},{"name":"Department of Medicine, Weill Cornell Medicine, New York, NY"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"233","reference":[{"key":"e_1_3_7_2_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00520-013-1887-3"},{"key":"e_1_3_7_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.canep.2019.05.013"},{"key":"e_1_3_7_4_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00520-014-2437-3"},{"key":"e_1_3_7_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(10)62344-6"},{"key":"e_1_3_7_6_2","doi-asserted-by":"publisher","DOI":"10.1093\/jnci\/94.19.1458"},{"key":"e_1_3_7_7_2","unstructured":"NCCN Clinical Practice Guidelines 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