[Current diagnostic and treatment practices for different stages of prostate cancer-real-world data from a nationwide survey by the German Society for Immuno- and Targeted Therapy (DGFIT)].

backgroundMany new options exist for the diagnosis and stage-appropriate treatment of prostate cancer (PCa). The aim of the survey conducted by the German Society for Immuno- and Targeted Therapy (DGFIT) was to capture the real-world evidence for the diagnosis and treatment of various stages of PCa (metastatic hormone-sensitive prostate cancer [mHSPC] and metastatic castration-resistant prostate cancer [mCRPC]) in Germany. MATERIALS AND

methodsIn August 2025, urologists in Germany were voluntarily surveyed using a standardized questionnaire accessible via QR code. The survey was open for 10 weeks. The questionnaire comprised 22 questions on the diagnosis and treatment of various stages of PCa. Topics included the use of multiparametric MRI (mpMRI), type of prostate biopsy including the fusion technique, staging, treatment of mHSPC and mCRPC, molecular testing, and workplace/person/position.

resultsA total of 136 urologists participated (76% male); 52% worked in private practice and 48% in a department, of which 16% were at a university hospital. Multiparametric MRI was performed more frequently in departments (77%) and less frequently in private practices (55%). Prostate biopsy was performed transrectally in 50% of cases (60% in private practices) and transperineally in 36% (predominantly at university hospitals, 91%). Fusion imaging was used by 81% of participants, more frequently at university hospitals and departments (100% and 93%, respectively) compared to private practices (59%). Staging examinations using prostate-specific membrane antigen positron-emission tomography/CT (PSMA-PET/CT) were predominantly performed at university hospitals (73%), while conventional imaging was the most common method in private practices and departments (81% and 75%, respectively). Regardless of the workplace, mHSPC therapy involved the combination of ADT and apalutamide (ADT/enzalutamide 16%, ADT/darolutamide/docetaxel 10%) in 62% of cases. Molecular testing was conducted in 50% of cases, more frequently at university hospitals (91%) compared to private practices (42%). Initial therapy for mCRPC involved docetaxel in 31%, a combination of poly-ADP ribose polymerase inhibitor (PARPI)/novel hormonal therapy (NHT) in 29%, switch to another NHT in 18%, and lutetium in 4%.

conclusionThis DGFIT survey represents the first systematic collection of real-world data on the diagnostic and treatment practices for PCa in Germany. Significant differences between private practices and hospitals are evident in PCa diagnosis and treatment. These differences include the use of mpMRI, the type of biopsy, the type of staging examinations, and molecular testing. In the treatment of mHSPC, the combination of ADT/apalutamide is established regardless of the workplace. A standardized therapy for mCRPC does not yet exist. The reasons for the differences between hospitals and private practices (availability, additional costs for urologists and patients, etc.) are unclear and must be investigated promptly to achieve optimal patient care in the future.