Advanced prostate cancer management by urologist: a real-life national survey in Brazil

Purpose: To address key challenges of treating advance prostate cancer (APC) faced by urologists, a nationwide survey was conducted. Although androgen receptor pathway inhibitors (ARPis) and other systemic agents have become standard treatments of APC, it is unclear how urologists have integrated these into their practice. Methods: A cross-sectional, closed 27-item was developed to investigate the impact of regional aspects, additional training and regulatory barriers on management of advanced prostate cancer. The target respondents were urologists who are members of the Brazilian Society of Urology (SBU). Our study evaluated various aspects of these new therapeutic strategies in a country with limited healthcare resources. Results: Of 557 respondents, 465 completed the survey. Most 287 (58%) worked in both private and public systems and 19% were urooncologists and 7% were female. ARPIs prescription analysis showed that 10% prescribe in the more resource-limited regions (center-north vs 24% in south/southeast). Urooncologists were significantly more inclined to prescribe ARPIs, and ADT for radiotherapy compared to general urologists (43%vs17%, 38%vs18%, respectively, p < 0.001 for both). While 76% of urologists reported treating metastatic patients, less than 35% prescribed ADT. Conversely, 9 (1.6%) reported prescribing ARPIs without medical or regulatory concerns. Sampling limitations of online surveys are possible. Conclusion: Despite increasing evidence favoring use of ARPIs, this study provides insights into barriers on the management of advanced prostate cancer. Wider dissemination of updated education in new hormonal therapies may help to bridge this gap.