Treatment options have evolved for metastatic castration-resistant prostate cancer (mCRPC). The aim of our study was to examine real-world (RW) treatment patterns and survival for individuals with mCRPC via a systematic literature review of RW observational studies.

Electronic databases (PubMed, Embase, and the Cochrane Library) and key conferences (2022–2025) were systematically searched for reports published between January 2015 and June 2025 on treatment patterns and RW overall survival (OS) in mCRPC.

From 7727 articles retrieved, 45 studies met the inclusion criteria. Most studies were from the USA. Bone metastases were present in ≥80% and visceral metastases in ≤28% of cases at mCRPC diagnosis. Androgen receptor pathway inhibitors (ARPIs) were the first-line treatment most frequently used for mCRPC (≥50% in most studies). Chemotherapy was the second most common first-line mCRPC treatment and was more common in Europe and Oceania than in the USA. Use of radiopharmaceuticals, olaparib, and sipuleucel-T in first-line mCRPC was low in most studies (<10%). ARPI-to-ARPI from the first to the second line was the most common sequence in the US studies. Median RW OS was ≤34 mo from either mCRPC diagnosis or initiation of first-line mCRPC treatment in most studies.

The findings showed that ARPIs are the most frequent first- and second-line treatments in mCRPC, and back-to-back ARPI sequencing is also common practice, especially in the USA, despite the availability of therapies beyond ARPIs. The findings highlight the need to optimize treatment beyond systemic hormone therapy in this setting.

Chemotherapy

Metastatic castration-resistant prostate cancer

Novel hormonal agents

Prostate cancer

Real-world treatment

© 2025 The Authors. Published by Elsevier B.V. on behalf of European Association of Urology.