FOR PATIENTS with metastatic castration-sensitive prostate cancer (mCSPC), also known as metastatic hormone-sensitive prostate cancer, evidence strongly supports the use of treatment intensification. Despite its proven survival benefits and endorsement in major clinical guidelines, many eligible patients in the United States still do not receive this recommended first-line approach.
The IMPLEMENT study explored why first-line treatment intensification remains underutilised and how clinicians’ behaviours, beliefs, and environments influence its uptake. Using a combination of qualitative and quantitative research, the study examined the barriers and facilitators affecting both urologists and oncologists.
Understanding Barriers to Treatment Intensification
The study found that the reasons behind the limited use of treatment intensification in mCSPC are complex and multifactorial. Key barriers included limited knowledge, insufficient clinical support, and difficulties in decision-making. Psychological factors also played a role, particularly anticipated regret. Physicians who feared missing an opportunity to extend survival were more likely to intensify treatment, while those worried about side effects or reducing quality of life were less likely to do so.
Differences between medical specialties were also evident. Oncologists tended to report more facilitators, including better clinical resources and stronger motivation to maximise patient survival. Urologists, on the other hand, were more affected by habitual practices, resource limitations, and lower confidence in intensifying therapy.
Collaborative Solutions for Better Practice in mCSPC
The final phase of the IMPLEMENT study aimed to co-create practical interventions to enhance uptake of treatment intensification in mCSPC. Cross-specialty tumour boards emerged as the most promising solution, fostering collaboration between urologists and oncologists. Virtual tumour boards, accessible to community physicians and offering continuing education credits, were identified as a particularly effective strategy.
By addressing educational, behavioural, and structural barriers, this approach could help align clinical practice with evidence-based guidelines. Encouraging collaboration, knowledge sharing, and decision support may ultimately improve patient outcomes and ensure that more individuals with metastatic castration-sensitive prostate cancer benefit from optimal treatment intensification.
Reference
Loeb S et al. Barriers and facilitators of treatment intensification in metastatic castration-sensitive prostate cancer. JAMA Netw Open. 2025;8(10):e2535728.
