Self-report. In randomized trials, survival increased by approximately 50% in men with metastatic castration-sensitive prostate cancer who received dual therapy with a gonadotropin-releasing hormone (GnRH) agonist plus chemotherapy or an androgen receptor pathway inhibitor (ARPI) at diagnosis, compared In men who received GnRH agonist alone [1]. This has led to national prostate cancer guidelines now recommending “dual therapy” with a GnRH agonist and chemotherapy with docetaxel or an ARPI.

We conducted a study of all men in the National Prostate Cancer Registry (NPCR) who had metastatic prostate cancer in the years 2008–2020 at diagnosis to investigate the introduction of dual therapy into routine clinical care and survival in this group of men. [2].

The proportion of men receiving dual therapy within 6 months of diagnosis rose from 1% among men diagnosed in 2016 to 44% in 2020. The increase was largest among men younger than 65 years of age at diagnosis, and by 2020, 73% of these men dual therapy. While the corresponding percentage reached 17 percent among men over the age of 80 years. The 5-year survival rate among all men with metastatic prostate cancer regardless of treatment increased from 26% in 2008-2012 to 35% in 2017-2020, an increase of 6 months, and the increase was greatest among men who were younger About 80 years old. .

We found that dual therapy for men with metastatic prostate cancer sharply increased at diagnosis between 2008 and 2020, while simultaneously improving survival for this group. Observational studies cannot prove causality, but our results show a clear temporal relationship between the introduction of dual therapy and improved survival.

One can reasonably expect a continued increase in dual therapy and, hopefully, a rapid introduction into the clinic of triple therapy, i.e. hormonal therapy (GnRH agonist) plus chemotherapy and ARPI, which has been shown to provide additional survival gains.

Our results suggest that clinically relevant improvements in survival could be expected if men with metastatic prostate cancer received more intensive treatment according to national guidelines.