Observational studyJCO oncology practice2026
Interprovider Variation in Initiation of Bone-Modifying Agents for Patients With Prostate Cancer.
Observational study in JCO oncology practice, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
purposeOncology clinical practice guidelines recommend bone-modifying agents (BMAs) to decrease skeletal-related events for patients with metastatic castration-resistant prostate cancer (mCRPC) and against BMAs to decrease skeletal-related events in metastatic castration-sensitive prostate cancer (mCSPC). Previous studies have identified gaps in guideline-concordant BMA use, but interprovider variation is poorly understood.
methodsWe conducted a multicenter, retrospective, cohort study of patients diagnosed with prostate cancer and bone metastases during 2020-2021. The sample included three health systems in the Northeastern United States: two community-based networks and one academic cancer center. Patient characteristics and BMA use (zoledronic acid and denosumab) were ascertained via chart review. The outcomes of interest were BMA overuse during castration-sensitive prostate cancer (CSPC; defined as BMA initiation before emergence of castration-resistant prostate cancer [CRPC], among patients without a comorbid condition for which BMA therapy may be appropriate: osteoporosis, osteopenia, or osteoporotic fracture) and appropriate use during CRPC (BMA initiation after emergence of CRPC).
resultsThere were 153 eligible patients, 51 from each health system. At diagnosis, 14 (9%) patients had documented osteoporosis or osteopenia, 22 (14%) had previous osteoporotic fracture, and 36 (24%) had chronic renal insufficiency. Among 95 patients assessable for overuse during CSPC, 16% (n = 17) received BMA (ranging from 13% to 21% among the three systems). Among 55 patients who developed CRPC, 44% (n = 24) had initiated BMA therapy as of most recent follow-up. There was greater variation in use during CRPC, ranging from 22% to 54% across the three systems.
conclusionBMA overuse in mCSPC was rare, potentially reflecting de-implementation following evidence of lack of benefit. Appropriate BMA use for patients with mCRPC varies substantially among clinicians and health care systems. Interventions to increase guideline-concordant care may improve outcomes.
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