Multicenter retrospective cohort study of treatment patters and attrition in metastatic castration-resistant prostate cancer

Rapid expansion of the therapeutic landscape for metastatic castration-resistant prostate cancer (mCRPC) has increased the complexity of treatment selection and sequencing. A multicenter retrospective cohort study using the Flatiron Health Research Database investigated treatment patterns and attrition rates in mCRPC patients who initiated first-line therapy between January 1, 2021, and June 30, 2025 (n=5096). In this cohort study, 54% of patients received second-line treatment and 26% received third-line treatment. Androgen receptor pathway inhibitors were the most common treatments in first (79.3%) and second (41.1%) lines with decreasing use in subsequent lines. Taxane use increased from 12.5% in first-line treatment to 34.9% in second-line treatment and became the most common third-line treatment (36.4%). The authors conclude that these findings suggest that there is a need for optimized sequencing strategies, more efficacious frontline therapies, and interventions to improve access to treatment for mCPRC.