Real-world factors associated with early combination therapy initiation in metastatic hormone-sensitive prostate cancer.

Abstract

e13722 Background: Combination systemic therapy (CST) improves survival in patients with metastatic hormone-sensitive prostate cancer, but this approach remains underutilized. In our study, we examined in an academic practice factors associated with a non-CST approach to further explore opportunities to address this important care gap. Methods: We conducted a retrospective study of patients with newly diagnosed mHSPC treated within the Mount Sinai Health System through 2025. The primary outcome was receipt of CST within 3 months of metastatic diagnosis, and secondary outcome is CST at 6 months. Sociodemographic and clinical characteristics were analyzed using univariable and multivariable logistic regression models were to identify factors associated with early treatment intensification. Results: Among 205 patients with newly diagnosed mHSPC, 136 (66.3%) received combination therapy within 3 months of diagnosis, and 148 (72.2%) received treatment intensification within 6 months. Baseline sociodemographic and clinical characteristics were similar between groups. In multivariable analysis, African American patients were significantly less likely to receive early combination therapy compared with non-Hispanic White patients (OR 0.37, 95% CI 0.14 to 0.97; P = 0.048). Higher PSA at diagnosis was independently associated with increased odds of early combination therapy (OR 1.34 per 1 unit increase in log(PSA + 1), 95% CI 1.08 to 1.68; P = 0.009). Medicaid insurance demonstrated a trend toward higher odds of early combination therapy compared with commercial insurance, though this did not reach statistical significance after adjustment (OR 3.62, 95% CI 1.02 to 15.37; P = 0.058). No significant associations were observed for age, primary language, distance from the treatment facility, ECOG performance status, Gleason Grade Group, or metastatic burden. Conclusions: In this real-world cohort study from a large urban academic health system, African American race was independently associated with a lower likelihood of early CST, while higher PSA at diagnosis was associated with a higher likelihood. Differences in insurance payor may play a role as well. These findings highlight the critical need to address these disparities in mHSPC. Multivariable model: combination therapy within 3 months. Variable Adjusted OR (95% CI) P value African American vs White 0.37 (0.14–0.97) 0.048 Hispanic vs White 0.61 (0.20–1.92) 0.395 Medicaid vs Commercial 3.62 (1.02–15.37) 0.058 Spanish vs English 3.16 (0.73–17.08) 0.141 Outside NYC vs Within NYC 2.20 (0.72–7.77) 0.186 Age (per year), per 1-year increase 1.00 (0.96–1.04) 0.940 PSA (log[PSA+1]), per 1-unit increase 1.34 (1.08–1.68) 0.009 ECOG ≥2 vs 0–1 0.83 (0.31–2.29) 0.714 Gleason Grade Group 3–5 vs 1–2 2.04 (0.56–7.38) 0.272 High vs Low metastatic burden 1.15 (0.47–2.88) 0.758 Adjusted for sociodemographic and baseline disease factors.