The Conundrum of Treating de novo metastatic Hormone-Sensitive Prostate Cancer
Abstract With the heterogeneous use and interpretation of next-generation molecular imaging and approval of new treatment strategies, therapeutic decision-making for de novo metastatic hormone-sensitive prostate cancer (mHSPC) is becoming increasingly challenging. It is conceivable that patients are...
Saved in:
| Main Authors: | , , , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Nature Portfolio
2025-04-01
|
| Series: | Scientific Reports |
| Subjects: | |
| Online Access: | https://doi.org/10.1038/s41598-025-96065-9 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1850187392042926080 |
|---|---|
| author | Tessa van Elst Niven Mehra Sjaak Bloem André N. Vis Bart P. Wijsman Daphne Luijendijk-de Bruin Joyce M. van Dodewaard-de Jong Pieter L. van den Berg Jules Lavalaye Shafak Aluwini Derya Yakar Daniela E. Oprea-Lager Peter F. A. Mulders Haiko J. Bloemendal Jean-Paul A. van Basten |
| author_facet | Tessa van Elst Niven Mehra Sjaak Bloem André N. Vis Bart P. Wijsman Daphne Luijendijk-de Bruin Joyce M. van Dodewaard-de Jong Pieter L. van den Berg Jules Lavalaye Shafak Aluwini Derya Yakar Daniela E. Oprea-Lager Peter F. A. Mulders Haiko J. Bloemendal Jean-Paul A. van Basten |
| author_sort | Tessa van Elst |
| collection | DOAJ |
| description | Abstract With the heterogeneous use and interpretation of next-generation molecular imaging and approval of new treatment strategies, therapeutic decision-making for de novo metastatic hormone-sensitive prostate cancer (mHSPC) is becoming increasingly challenging. It is conceivable that patients are treated differently in another country, hospital or by another clinician. Here, we aim to provide insights into the clinical practices, challenges, and unmet needs in the management of de novo mHSPC.In this explorative mixed-method study, a survey was sent to urologists and oncologists in 13 Dutch hospitals from the TripleAiM1 network. Additionally, four patient cases were discussed in multi-disciplinary team consultations in four of these hospitals. Results from the survey and patient cases were then discussed in focus group sessions. Three sessions were held with the same expert panel, comprising urologists, medical oncologists, a nuclear medicine physician and radiation oncologist. Major themes were identified and analysed using the Matrix method. Of the 91 surveys distributed, 27 urologists and 19 oncologists responded. Patients with low-volume (LV) disease showed most practice variation; ranging from curative to palliative intent and from single to triplet therapies. Reasons given for this variation include the heterogeneous aspect of LV disease, ambiguous definitions, varying interpretations of study data, lead-time in adoption of novel treatment strategies, and guideline gaps. Adding to this divergence are differences in interpretation of metastatic volume. As the majority of physicians (36/46) use PSMA-PET/CT for staging, while LV and high-volume per CHAARTED criteria are defined on conventional imaging. On a scale of 0–10, metastatic volume (8.5), performance score (8.6), and patient preferences (9.0) were considered the most important factors for selecting treatments. This did not differ significantly between specialties, but showed large dispersion within specialties, suggesting variation at the individual physician level. In conclusion, this study provides insights into clinical practices and challenges in the management of de novo mHSPC. By elucidating the perspectives of Dutch physicians, our findings contribute to a better understanding of the complexities involved in treatment decision-making. Moving forward, there is a need for consensus on definitions, imaging modalities for staging, and treatment selection given the altered diagnostic and therapeutic landscape. |
| format | Article |
| id | doaj-art-d8b2a9bab2824aeb89b45d16a004e426 |
| institution | OA Journals |
| issn | 2045-2322 |
| language | English |
| publishDate | 2025-04-01 |
| publisher | Nature Portfolio |
| record_format | Article |
| series | Scientific Reports |
| spelling | doaj-art-d8b2a9bab2824aeb89b45d16a004e4262025-08-20T02:16:06ZengNature PortfolioScientific Reports2045-23222025-04-0115111210.1038/s41598-025-96065-9The Conundrum of Treating de novo metastatic Hormone-Sensitive Prostate CancerTessa van Elst0Niven Mehra1Sjaak Bloem2André N. Vis3Bart P. Wijsman4Daphne Luijendijk-de Bruin5Joyce M. van Dodewaard-de Jong6Pieter L. van den Berg7Jules Lavalaye8Shafak Aluwini9Derya Yakar10Daniela E. Oprea-Lager11Peter F. A. Mulders12Haiko J. Bloemendal13Jean-Paul A. van Basten14 Department of urology, Canisius Wilhelmina HospitalDepartment of medical oncology, Radboud University Medical CentreCentre for supply chain management & marketing, Nyenrode Business UniversityDepartment of urology, Amsterdam University Medical Centre Department of urology, Elisabeth-TweeSteden HospitalDepartment of urology, Martini HospitalDepartment of medical oncology, Meander Medical CentreDepartment of medical oncology, Tergooi Medical CentreDepartment of nuclear medicine, St. Antonius HospitalDepartment of radiotherapy, University Medical Centre GroningenDepartment of radiology, University Medical Centre GroningenDepartment of nuclear medicine, Radboud University Medical CentreDepartment of urology, Radboud University Medical CentreDepartment of medical oncology, Radboud University Medical Centre Department of urology, Canisius Wilhelmina HospitalAbstract With the heterogeneous use and interpretation of next-generation molecular imaging and approval of new treatment strategies, therapeutic decision-making for de novo metastatic hormone-sensitive prostate cancer (mHSPC) is becoming increasingly challenging. It is conceivable that patients are treated differently in another country, hospital or by another clinician. Here, we aim to provide insights into the clinical practices, challenges, and unmet needs in the management of de novo mHSPC.In this explorative mixed-method study, a survey was sent to urologists and oncologists in 13 Dutch hospitals from the TripleAiM1 network. Additionally, four patient cases were discussed in multi-disciplinary team consultations in four of these hospitals. Results from the survey and patient cases were then discussed in focus group sessions. Three sessions were held with the same expert panel, comprising urologists, medical oncologists, a nuclear medicine physician and radiation oncologist. Major themes were identified and analysed using the Matrix method. Of the 91 surveys distributed, 27 urologists and 19 oncologists responded. Patients with low-volume (LV) disease showed most practice variation; ranging from curative to palliative intent and from single to triplet therapies. Reasons given for this variation include the heterogeneous aspect of LV disease, ambiguous definitions, varying interpretations of study data, lead-time in adoption of novel treatment strategies, and guideline gaps. Adding to this divergence are differences in interpretation of metastatic volume. As the majority of physicians (36/46) use PSMA-PET/CT for staging, while LV and high-volume per CHAARTED criteria are defined on conventional imaging. On a scale of 0–10, metastatic volume (8.5), performance score (8.6), and patient preferences (9.0) were considered the most important factors for selecting treatments. This did not differ significantly between specialties, but showed large dispersion within specialties, suggesting variation at the individual physician level. In conclusion, this study provides insights into clinical practices and challenges in the management of de novo mHSPC. By elucidating the perspectives of Dutch physicians, our findings contribute to a better understanding of the complexities involved in treatment decision-making. Moving forward, there is a need for consensus on definitions, imaging modalities for staging, and treatment selection given the altered diagnostic and therapeutic landscape.https://doi.org/10.1038/s41598-025-96065-9Metastatic hormone-sensitive prostate cancerImagingTreatmentsGuidelinesPractice variation |
| spellingShingle | Tessa van Elst Niven Mehra Sjaak Bloem André N. Vis Bart P. Wijsman Daphne Luijendijk-de Bruin Joyce M. van Dodewaard-de Jong Pieter L. van den Berg Jules Lavalaye Shafak Aluwini Derya Yakar Daniela E. Oprea-Lager Peter F. A. Mulders Haiko J. Bloemendal Jean-Paul A. van Basten The Conundrum of Treating de novo metastatic Hormone-Sensitive Prostate Cancer Scientific Reports Metastatic hormone-sensitive prostate cancer Imaging Treatments Guidelines Practice variation |
| title | The Conundrum of Treating de novo metastatic Hormone-Sensitive Prostate Cancer |
| title_full | The Conundrum of Treating de novo metastatic Hormone-Sensitive Prostate Cancer |
| title_fullStr | The Conundrum of Treating de novo metastatic Hormone-Sensitive Prostate Cancer |
| title_full_unstemmed | The Conundrum of Treating de novo metastatic Hormone-Sensitive Prostate Cancer |
| title_short | The Conundrum of Treating de novo metastatic Hormone-Sensitive Prostate Cancer |
| title_sort | conundrum of treating de novo metastatic hormone sensitive prostate cancer |
| topic | Metastatic hormone-sensitive prostate cancer Imaging Treatments Guidelines Practice variation |
| url | https://doi.org/10.1038/s41598-025-96065-9 |
| work_keys_str_mv | AT tessavanelst theconundrumoftreatingdenovometastatichormonesensitiveprostatecancer AT nivenmehra theconundrumoftreatingdenovometastatichormonesensitiveprostatecancer AT sjaakbloem theconundrumoftreatingdenovometastatichormonesensitiveprostatecancer AT andrenvis theconundrumoftreatingdenovometastatichormonesensitiveprostatecancer AT bartpwijsman theconundrumoftreatingdenovometastatichormonesensitiveprostatecancer AT daphneluijendijkdebruin theconundrumoftreatingdenovometastatichormonesensitiveprostatecancer AT joycemvandodewaarddejong theconundrumoftreatingdenovometastatichormonesensitiveprostatecancer AT pieterlvandenberg theconundrumoftreatingdenovometastatichormonesensitiveprostatecancer AT juleslavalaye theconundrumoftreatingdenovometastatichormonesensitiveprostatecancer AT shafakaluwini theconundrumoftreatingdenovometastatichormonesensitiveprostatecancer AT deryayakar theconundrumoftreatingdenovometastatichormonesensitiveprostatecancer AT danielaeoprealager theconundrumoftreatingdenovometastatichormonesensitiveprostatecancer AT peterfamulders theconundrumoftreatingdenovometastatichormonesensitiveprostatecancer AT haikojbloemendal theconundrumoftreatingdenovometastatichormonesensitiveprostatecancer AT jeanpaulavanbasten theconundrumoftreatingdenovometastatichormonesensitiveprostatecancer AT tessavanelst conundrumoftreatingdenovometastatichormonesensitiveprostatecancer AT nivenmehra conundrumoftreatingdenovometastatichormonesensitiveprostatecancer AT sjaakbloem conundrumoftreatingdenovometastatichormonesensitiveprostatecancer AT andrenvis conundrumoftreatingdenovometastatichormonesensitiveprostatecancer AT bartpwijsman conundrumoftreatingdenovometastatichormonesensitiveprostatecancer AT daphneluijendijkdebruin conundrumoftreatingdenovometastatichormonesensitiveprostatecancer AT joycemvandodewaarddejong conundrumoftreatingdenovometastatichormonesensitiveprostatecancer AT pieterlvandenberg conundrumoftreatingdenovometastatichormonesensitiveprostatecancer AT juleslavalaye conundrumoftreatingdenovometastatichormonesensitiveprostatecancer AT shafakaluwini conundrumoftreatingdenovometastatichormonesensitiveprostatecancer AT deryayakar conundrumoftreatingdenovometastatichormonesensitiveprostatecancer AT danielaeoprealager conundrumoftreatingdenovometastatichormonesensitiveprostatecancer AT peterfamulders conundrumoftreatingdenovometastatichormonesensitiveprostatecancer AT haikojbloemendal conundrumoftreatingdenovometastatichormonesensitiveprostatecancer AT jeanpaulavanbasten conundrumoftreatingdenovometastatichormonesensitiveprostatecancer |