Your window into Astellas’ world of patient-centered and science-driven healthcare, as told by the experts who bring it to life.
This article is primarily based on U.S. medical guidelines and clinical practices. Please be aware that these may differ from those in other countries, and caution should be exercised when applying the information to specific healthcare contexts.
When a patient is facing metastatic prostate cancer, getting the right treatment at the right time may help them live longer.
Medical guidelines are clear: patients with metastatic castration-sensitive prostate cancer (mCSPC) should receive a combination of therapies as their first-line treatment. This is known as treatment intensification or combination therapy, an approach that combines several medications or treatment methods to treat the cancer.
Yet in practice, only about one-third of patients are receiving this recommended approach.1
The Behavioral Science Consortium (BSC) partnered with Medical Affairs US to find out why – and, more importantly, what can be done about it. In Project IMPLEMENT, we used behavioral science to uncover the real-world factors that shape clinician decision-making. To make sure we captured the full picture, we collaborated with the BSC Faculty, implementation science expert Dr. Judith Dyson, and two leading voices in prostate cancer care: medical oncologist Dr. Neeraj Agarwal and urologist Dr. Stacy Loeb.
The obstacles we found were not about physicians lacking compassion or effort. They were human barriers:
We identified behavior change techniques (BCTs) that may help address these barriers, from decision-making tools to modular learning programs, and platforms to support collaboration between urologists and oncologists.
While knowledge turned out to be a critical gap, the IMPLEMENT project showed that information alone isn't enough. Changing behavior requires understanding also the psychological and practical factors that influence clinical decisions – and addressing them with targeted, evidence-based solutions.
Laura de Ruiter
Behavioral Science Consortium Lead
"Doctors are human, too. They’re subject to the same psychological, social and environmental forces that all of us are,” says BSC’s Laura de Ruiter. “The solution isn’t to expect them to be superhuman, but to use our understanding of human behavior to support them in making the best decisions – for their patients, and for themselves.”
By applying behavioral science, Project IMPLEMENT aims to help clinicians bridge the gap between medical recommendation and clinical practice, supporting better decisions, better care, and ultimately, better outcomes for patients
Because being patient-centric means understanding not just what patients need, but also what makes it hard for those caring for them to deliver the best care and helping to overcome those barriers.
Learn more about Project IMPLEMENT and our findings:
Loeb S, Agarwal N, El-Chaar N, et al. Barriers to and facilitators of first-line treatment intensification in metastatic castration-sensitive prostate cancer: The IMPLEMENT study [abstract]. American Society of Clinical Oncology Genitourinary Cancers Symposium (ASCO-GU); 2024. Abstract #224. Click here to get to the plain language summary.
Agarwal N, Loeb S, El-Chaar N, et al. Barriers to and facilitators of first-line treatment intensification (TI) in metastatic castration-sensitive prostate cancer (mCSPC) by practice setting and intensification frequency: A sub-analysis of IMPLEMENT [abstract]. American Society of Clinical Oncology-Genitourinary Cancers Symposium (ASCO-GU); 2025. Abstract #48. Click here to get to the plain language summary.
Loeb S, Agarwal N, El-Chaar N, et al. Resources to address challenges in first-line treatment intensification in metastatic castration-sensitive prostate cancer (mCSPC): A discrete choice experiment [abstract]. American Society of Clinical Oncology (ASCO); 2024. Abstract #5087. Click here to get to the plain language summary.
Loeb S, Agarwal N, El-Chaar N, et al. Differences in barriers and facilitators to first-line treatment intensification in metastatic castration-sensitive prostate cancer between urologists and oncologists: A sub-analysis of the IMPLEMENT study [abstract]. American Urological Association (AUA) Annual Meeting; 2024. Presentation PD01-02. Click here to get to the plain language summary.
1 Schaeffer EM, et al. Prostate Cancer, Version 4.2023, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw. 2023;21(10):1067–96. 2. Wala J, et al. J Clin Oncol. 2023;41(20):3584–90.
2 Swami U, et al. J Urol. 2023;209(6):1120–31.
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