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10.4103/aja202616
Disease characteries, treatment patterns, and oncological outcomes of de novo metastatic hormone-sensitive prostate cancer: real-world experience from a multicenter Asian cohort
Ivan Ching-Ho Ko1,2
Kevin Cheuk Kin Cheng1,2
Chris Ho-Ming Wong1,2
Joycelyn Yung Yung Lim1,2
Candice Hiu Tung Mok1,2
Cheuk Yi Tang1,2
Brian Chun Fai Kwok1,2
Yi-Hong Zhou1
Chi Ho Leung1
Peggy Sau Kwan Chu3
Joseph Kai Man Li4
Chi Fai Ng1,2,5,
1SH Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong SAR, China
2Department of Surgery, Prince of Wales Hospital, Hong Kong SAR, China
3Department of Surgery, Tuen Mun Hospital, Hong Kong SAR, China
4Department of Surgery, Pok Oi Hospital, Hong Kong SAR, China
5Department of Surgery, North District Hospital, Hong Kong SAR, China
Correspondence: Dr. CF Ng (ngcf@surgery.cuhk.edu.hk)
Received: 09 September 2025; Accepted: 31 March 2026; published online: 14 July 2026
| Abstract |
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This multicenter retrospective study assessed real-world treatment patterns and outcomes in de novo metastatic hormone-sensitive prostate cancer (mHSPC) across five urological centers in Hong Kong (China; from 2016 to 2023). Of 3308 patients, 814 (24.6%) presented with de novo mHSPC. High-volume and high-risk disease were present in 59.1% and 53.8% of patients, respectively. Despite guidelines favoring intensified therapy, androgen deprivation therapy (ADT) monotherapy remained the most common treatment (52.0%), while only 28.7% received upfront chemotherapy (20.5%) or androgen receptor pathway inhibitors (ARPI; 8.2%). During a median 40-month follow-up period, 48.4% of patients died and 60.1% progressed to castration-resistant prostate cancer (CRPC) within a median of 19 months. Five-year overall survival rates were highest for ARPI (64.9%), followed by chemotherapy (53.5%) and monotherapy (38.7%), with corresponding 5-year CRPC-free survival rates of 73.5%, 7.7%, and 15.0%, respectively. Upfront chemotherapy and ARPI demonstrated significant reductions in cancer-specific mortality compared to ADT monotherapy (chemotherapy hazard ratio [HR]: 0.58, 95% confidence interval [CI]: 0.41–0.82, P = 0.002; ARPI HR: 0.32, 95% CI: 0.17–0.62, P < 0.001). High-volume disease (HR: 2.14, 95% CI: 1.52–3.01, P < 0.001) and ISUP Grade 4 or 5 (HR: 5.70, 95% CI: 1.82–17.87, P = 0.003) conferred increased risk. Upfront chemotherapy and ARPI were independently associated with improved overall survival (chemotherapy HR: 0.56, 95% CI: 0.41–0.78, P < 0.001; ARPI HR: 0.41, 95% CI: 0.24–0.69, P < 0.001). High-volume mHSPC (HR: 1.65, 95% CI: 1.24–2.21, P < 0.001) and ISUP Grade 4 or 5 (HR: 2.38, 95% CI: 1.22–4.65, P = 0.011) were significant adverse prognostic factors. Advanced age at diagnosis was associated with increased all-cause mortality (HR: 1.02, 95% CI: 1.00–1.03, P = 0.037). These findings highlight an urgent need to improve adoption of intensified treatment strategies for optimal patient outcomes.
Keywords: androgen antagonists; androgen receptor antagonists; castration-resistant prostatic neoplasms; neoplasm metastasis;
prostatic neoplasms
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