Stephen J. Freedland, MD, on the benefits of mCRPC treatments translating to the real world

A recent study examined the relationship between randomized controlled trials and real-world efficacy of prostate cancer treatments.¹ Investigators found that benefits of treatments that are observed in trials also appear in the real world.

In a recent interview with Urology Times®, study author Stephen J. Freedland, MD, discussed the findings, one of which was that real-world overall survival gains appeared to increase with the duration a new therapy was on the market. When asked what factors he believed might contribute to this temporal increase, and how these factors might influence clinical decision-making when adopting new treatments, Freedland said there are 2 ways to look at the data.

“One is kind of the optimistic view of physicians learn better how to select the right patients for going on a drug, identifying those who really are going to benefit the most. We start to understand how to manage the [adverse events]. We understand when to stop, how long to stay on the drug, and that as we, as a field, gain collective knowledge about this drug, we can actually make it work even better,” said Freedland, a professor of urology at Cedars-Sinai in Los Angeles, California.

“The alternative is, just in general, we have a lot more drugs…We have more therapies. We're identifying patients earlier and earlier. It’s not necessarily the drug is working better, but we're starting it earlier…[Also,] we have better salvage therapies. When the patient is progressing on our drug, we have more options. So is it just, over time, patients live longer and are doing better as we get more therapies? Or are we actually learning how to use the drug? I think it’s probably a little bit of both, to be honest. I don't think in our data we can easily tease those 2 apart, though,” Freedland said.

REFERENCE

1. Axeen S, Chen AJ, Lakdawalla DN, et al. Do trial benefits predict real-world gains in metastatic castration resistant prostate cancer. JNCI Cancer Spectr. 2025;9(2):pkaf018. doi:10.1093/jncics/pkaf018