Physician preferences for metastatic hormone-sensitive prostate cancer treatment: A discrete choice experiment in China.

Abstract

e17086 Background: Androgen receptor pathway inhibitors (ARPIs) improve disease control and overall survival (OS) in metastatic hormone-sensitive prostate cancer (mHSPC). Unclear benefit-risk trade-offs may yield heterogeneous treatment selection and uneven clinical outcomes. This study explored Chinese physicians’ preferences and benefit-risk trade-offs for mHSPC therapies. Methods: Two-phase Discrete Choice Experiment (DCE) was conducted. Phase 1 included a systematic literature review (SLR) and qualitative interviews with 20 urologists to identify key DCE attributes and levels. Phase 2, online survey of 100 urologists in tertiary hospitals, each completed 36 choice sets comparing two hypothetical mHSPC treatment profiles defined by six attributes (2-3 levels). Random parameters logit model estimated preference weights, relative attributes importance (RAI) assessed attribute influence, marginal rates of substitution quantified efficacy-risk trade-offs. Results: A total of 100 urologists completed the survey, median years in practice were 15. Consistent with prior interviews and the systematic review, efficacy (PSA-related) and fall risk were key decision drivers. Physicians favored higher efficacy and lower risks. Greater OS gains (median: 5 years + 12 months vs. 5 years + 6 months; estimate 0.61, 95% CI: 0.44-0.77) and higher PSA response rates (50% vs. 30% ≤0.2 ng/mL at 3 months; estimate 0.56, 95% CI: 0.31-0.81) were preferred, while serious falls were least favored (≥5% vs none; estimate -0.83, 95% CI: -1.06 to -0.59). All attribute levels except rash differed significantly from baseline ( p < 0.05). Attributes ranking: efficacy attributes accounted for over 50% of total influence, with depth of PSA decline (PSA 0.02, PSA 0.2, PSA 90, RAI 22%), OS prolongation (RAI 20%), and PSA decline rate (RAI 18%). Among risks, serious-fall likelihood was the most influential (RAI 27%), followed by fatigue/asthenia (RAI 7%) and rash (RAI 6%). Trade-offs: to lower serious-fall risk, physicians would forgo 8.2 months of OS (95% CI: 5.2-11.1), 2.2 months for fatigue/asthenia (95% CI: 0.6-3.9) and 1.8 months for rash (95% CI: -0.2-3.9). Conclusions: Efficacy - particularly PSA-related indicators and OS- dominates mHSPC treatment choice. Serious-fall risk emerged as the most critical safety concern, physicians were willing to forgo meaningful OS to mitigate it. These findings highlight the importance of balancing efficacy and quality-of-life when selecting ARPI therapies, expected to inform clinical treatment selection in China.