Ashkan Mortezavi, urologist, robotic surgeon, and senior attending physician at University Hospital Zurich (USZ), shared on LinkedIn:
“Are we comparing early combination therapy with the best possible sequential strategy — or with suboptimal post-progression care?
That’s the question at the heart of our new editorial in European Urology.
In metastatic hormone-sensitive prostate cancer, we’ve spent a decade showing that more upfront is better. But a key question keeps getting overlooked:
What happened to the control arm after progression?
Across the pivotal mHSPC trials, the proportion of control-arm patients who ever received an androgen receptor signaling inhibitor after progressing ranged from 29% to 81%. When the “Why Post-Progression Care Changes the mHSPC Treatment Story” comparator is undertreated, part of the survival benefit we attribute to early combination may reflect unequal access to later-line therapy rather than true superiority of the upfront approach.
To be fair, incomplete uptake isn’t only about access — some patients declined further treatment, or were too unwell. But those reasons were never systematically reported. Which is precisely the problem: we can’t separate access from attrition from true treatment effect.
This matters. It shapes how we interpret OS, how we design trials, and whether carefully sequenced therapy could offer some patients the same benefit with less toxicity, lower cost, and lower cardiovascular risk. Trials that guarantee and explicitly document post-progression therapy remain essential.
Grateful to my co-authors Tom van der Hulle and Roderick van den Bergh.”
Title: What Comes After Matters: The Importance of Postprogression Care in Patients with Metastatic Hormone-sensitive Prostate Cancer
Authors: Ashkan Mortezavi, Tom van der Hulle, Roderick van den Bergh
Read also “Phase 3 ARANOTE Trial: Darolutamide Plus ADT in Black Patients With Metastatic Hormone-Sensitive Prostate Cancer” on OncoDaily.
