{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,30]],"date-time":"2026-03-30T14:57:45Z","timestamp":1774882665631,"version":"3.50.1"},"reference-count":21,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,3,30]],"date-time":"2026-03-30T00:00:00Z","timestamp":1774828800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Oncol."],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Clinical Decision Support Systems (CDSS) assist clinicians in making informed decisions based on clinical guidelines and comprehensive data. In prostate cancer (PC), particularly in patients receiving androgen deprivation therapy (ADT), early detection of castration-resistant prostate cancer (CRPC) and close monitoring of progression biomarkers are essential. This study evaluated the impact of a CDSS on the monitoring and clinical management of advanced PC patients in a hospital setting.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A retrospective, single-centre cohort study was conducted using structured patient-level data from the institutional Data Warehouse of Hospital La Fe (Valencia, Spain). The study included patients diagnosed with PC who received ADT and were analysed over two consecutive one-year periods: 15 September 2021 to 14 September 2022 (pre-implementation) and 15 September 2022 to 15 September 2023 (post-implementation of the CDSS). Primary outcomes included CRPC detection rates, classification of PSA kinetics instability, and use of palliative radiotherapy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>CDSS implementation was associated with higher CRPC detection rates (from 20.7% to 27.9%). The proportion of patients with unstable PSA kinetics increased after implementation (81.1% vs. 64.7%; p = 0.01). Although the increase in the use of palliative radiotherapy did not reach statistical significance, a modest rise was observed (from 11.7% to 15.1%).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>The introduction of the CDSS was associated with improved monitoring signals and earlier recognition of disease progression in ADT-treated patients. The system supported enhanced PSA-based risk stratification and more timely multidisciplinary coordination. Although longer follow-up and broader implementation are needed to confirm trends, the findings highlight the potential of digital tools to optimize routine PC management.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fonc.2026.1746456","type":"journal-article","created":{"date-parts":[[2026,3,30]],"date-time":"2026-03-30T14:13:40Z","timestamp":1774880020000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Monitoring prostate cancer under androgen-deprivation therapy: insights from the implementation of a clinical decision support system dashboard"],"prefix":"10.3389","volume":"16","author":[{"given":"\u00c1lvaro","family":"Mart\u00ednez-P\u00e9rez","sequence":"first","affiliation":[{"name":"Plataforma de Big Data, IA, Bioestad\u00edstica y Bioinform\u00e1tica, Instituto de Investigaci\u00f3n Sanitaria La Fe (IIS La Fe)","place":["Valencia, Spain"]},{"name":"Unidad Mixta de Investigacion en TICs aplicadas a la Reingenier\u00eda en Procesos Sociosanitarios, Instituto de Investigaci\u00f3n Sanitaria La Fe (IIS La Fe)","place":["Valencia, Spain"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gonzalo","family":"Collantes","sequence":"additional","affiliation":[{"name":"Unidad Mixta de Investigacion en TICs aplicadas a la Reingenier\u00eda en Procesos Sociosanitarios, Instituto de Investigaci\u00f3n Sanitaria La Fe (IIS La Fe)","place":["Valencia, Spain"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jos\u00e9\u2011Luis","family":"Ruiz\u2011Cerd\u00e1","sequence":"additional","affiliation":[{"name":"Servicio de Urolog\u00eda, Hospital Universitario y Polit\u00e9cnico La Fe","place":["Valencia, Spain"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Antonio","family":"Conde-Moreno","sequence":"additional","affiliation":[{"name":"Servicio de Oncolog\u00eda Radioter\u00e1pica, Hospital Universitario y Polit\u00e9cnico La Fe","place":["Valencia, Spain"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Regina","family":"Giron\u00e9s","sequence":"additional","affiliation":[{"name":"Servicio de Oncolog\u00eda M\u00e9dica, Hospital Universitario y Polit\u00e9cnico La Fe","place":["Valencia, Spain"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Beatriz","family":"Garcill\u00e1n","sequence":"additional","affiliation":[{"name":"The Medical Affairs Department, Johnson & Johnson","place":["Madrid, Spain"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Juli\u00e0","family":"Amengual","sequence":"additional","affiliation":[{"name":"Plataforma de Big Data, IA, Bioestad\u00edstica y Bioinform\u00e1tica, Instituto de Investigaci\u00f3n Sanitaria La Fe (IIS La Fe)","place":["Valencia, Spain"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mar\u00eda Eugenia","family":"Gas","sequence":"additional","affiliation":[{"name":"Plataforma de Big Data, IA, Bioestad\u00edstica y Bioinform\u00e1tica, Instituto de Investigaci\u00f3n Sanitaria La Fe (IIS La Fe)","place":["Valencia, Spain"]},{"name":"Unidad Mixta de Investigacion en TICs aplicadas a la Reingenier\u00eda en Procesos Sociosanitarios, Instituto de Investigaci\u00f3n Sanitaria La Fe (IIS La Fe)","place":["Valencia, Spain"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,3,30]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"63","DOI":"10.14740\/wjon1191","article-title":"Epidemiology of prostate cancer","volume":"10","author":"Rawla","year":"2019","journal-title":"World J Oncol"},{"key":"B2","doi-asserted-by":"publisher","first-page":"e0298764","DOI":"10.1371\/journal.pone.0298764","article-title":"Prostate cancer in Spain: A retrospective database analysis of hospital incidence and the direct medical costs","volume":"19","author":"Darb\u00e0","year":"2024","journal-title":"PloS One"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1007\/s10555-013-9474-0","article-title":"Androgen receptor signaling in prostate cancer","volume":"33","author":"Culig","year":"2014","journal-title":"Cancer Metastasis Rev"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.3747\/co.19.1298","article-title":"Androgen deprivation therapy in advanced prostate cancer: is intermittent therapy the new standard of care","volume":"19","author":"Klotz","year":"2012","journal-title":"Curr Oncol"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1016\/j.urology.2024.10.058","article-title":"Evaluating the importance of practice-level factors on adherence to prostate cancer treatment guidelines in urology","volume":"196","author":"Shore","year":"2025","journal-title":"Urology"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2015.64.2702","article-title":"Trial design and objectives for castration-resistant prostate cancer: updated recommendations from the prostate cancer clinical trials working group 3","volume":"34","author":"Scher","year":"2016","journal-title":"J Clin Oncol"},{"key":"B7","doi-asserted-by":"publisher","first-page":"11","DOI":"10.1016\/j.eururo.2011.08.026","article-title":"Contemporary role of androgen deprivation therapy for prostate cancer","volume":"61","author":"Pagliarulo","year":"2012","journal-title":"Eur Urol"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1016\/j.eururo.2024.04.010","article-title":"EAU\u2212EANM\u2212ESTRO\u2212ESUR\u2212ISUP\u2212SIOG guidelines on prostate cancer. Part II\u20142024 update: treatment of relapsing and metastatic prostate cancer","volume":"86","author":"Tilki","year":"2024","journal-title":"Eur Urol"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2119115","article-title":"Darolutamide and survival in metastatic, hormone\u2212sensitive prostate cancer","volume":"386","author":"Smith","year":"2022","journal-title":"N Engl J Med"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(22)00367-1","article-title":"Abiraterone plus prednisone added to androgen\u2212deprivation therapy and docetaxel in de novo metastatic castration\u2212sensitive prostate cancer (PEACE\u22121): a multicentre, open\u2212label, randomised, phase 3 study with a 2\u00d72 factorial design","volume":"399","author":"Fizazi","year":"2022","journal-title":"Lancet"},{"key":"B11","doi-asserted-by":"publisher","first-page":"192","DOI":"10.1016\/j.euo.2019.06.009","article-title":"Defining and measuring adherence in observational studies assessing outcomes of real-world active surveillance for prostate cancer: A systematic review","volume":"4","author":"Kith","year":"2021","journal-title":"Eur Urol Oncol"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.3389\/fonc.2022.1043411","article-title":"Analytical exploratory tool for healthcare professionals to monitor cancer patients\u2019 progress","volume":"12","author":"Valero-Ramon","year":"2023","journal-title":"Front Oncol"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.312.7023.71","article-title":"Evidence\u2212based medicine: what it is and what it isn\u2019t","volume":"312","author":"Sackett","year":"1996","journal-title":"BMJ"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.1016\/j.eururo.2024.03.027","article-title":"EAU-EANM-ESTRO-ESUR-ISUP-SIOG guidelines on prostate cancer\u20142024 update. Part I: screening, diagnosis, and local treatment with curative intent","volume":"86","author":"Cornford","year":"2024","journal-title":"Eur Urol"},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa040720","article-title":"Docetaxel plus prednisone or mitoxantrone plus prednisone for advanced prostate cancer","volume":"351","author":"Tannock","year":"2004","journal-title":"N Engl J Med"},{"key":"B16","doi-asserted-by":"publisher","first-page":"399","DOI":"10.1016\/j.euf.2021.04.003","article-title":"Overall survival after systemic treatment in high-volume versus low-volume metastatic hormone-sensitive prostate cancer: systematic review and network meta-analysis","volume":"8","author":"Wenzel","year":"2022","journal-title":"Eur Urol Focus"},{"key":"B17","doi-asserted-by":"publisher","DOI":"10.3389\/fonc.2023.1266369","article-title":"Improving the identification of high-risk non-metastatic castration-resistant prostate cancer patients in clinical practice","volume":"13","author":"Rosinha","year":"2024","journal-title":"Front Oncol"},{"key":"B18","doi-asserted-by":"publisher","DOI":"10.1002\/bco2.158","article-title":"Patterns of care for non-metastatic castration-resistant prostate cancer: A population-based study","volume":"3","author":"Malone","year":"2022","journal-title":"BJUI Compass"},{"key":"B19","doi-asserted-by":"publisher","first-page":"19113","DOI":"10.1038\/s41598-024-70292-y","article-title":"Clinical decision making in prostate cancer care\u2014evaluation of EAU-guidelines use and novel decision support software","volume":"14","author":"Engesser","year":"2024","journal-title":"Sci Rep"},{"key":"B20","doi-asserted-by":"publisher","DOI":"10.1007\/s11606-020-06124-2","article-title":"Implementation and impact of a risk-stratified prostate cancer screening algorithm as a clinical decision support tool in a primary care network","volume":"36","author":"Shah","year":"2021","journal-title":"J Gen Intern Med"},{"key":"B21","doi-asserted-by":"publisher","first-page":"25","DOI":"10.1016\/j.prnil.2020.06.003","article-title":"Prostate cancer trajectory-map: clinical decision support system for prognosis management of radical prostatectomy","volume":"9","author":"Park","year":"2021","journal-title":"Prostate Int"}],"container-title":["Frontiers in Oncology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fonc.2026.1746456\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,30]],"date-time":"2026-03-30T14:13:41Z","timestamp":1774880021000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fonc.2026.1746456\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,30]]},"references-count":21,"alternative-id":["10.3389\/fonc.2026.1746456"],"URL":"https:\/\/doi.org\/10.3389\/fonc.2026.1746456","relation":{},"ISSN":["2234-943X"],"issn-type":[{"value":"2234-943X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,30]]},"article-number":"1746456"}}