Survival trend in metastatic prostate cancer two decades of real-world data on overall survival from Germany

Abstract Background The management of metastatic prostate cancer (mPCa) has undergone revolutionary changes over the past two decades with the introduction of novel hormonal agents, chemotherapy combinations, PARP inhibitors, and radioligand therapies. This study evaluates the real-world impact of these therapeutic advances on overall survival (OS) in Germany. Methods We analyzed data from the German national cancer registry covering 657,499 prostate cancer cases diagnosed between 1999 and 2021. After exclusions, 54,890 patients with de novo metastatic disease (M1) were included. Primary outcome was median OS. Secondary outcomes included 3-, 5-, and 10-year survival rates. Time series analysis assessed temporal trends using augmented Dickey-Fuller tests and joinpoint regression. Results Median OS for M1 patients improved from 31.0 months (95% CI: 29.8–32.2) in 1999 to 37.0 months (35.6–38.4) in 2019 ( p < 0.001). This 19.4% improvement exceeded general life expectancy gains. Age-stratified analysis revealed disparate benefits: patients < 70 years experienced improvement from 34.0 to 49.0 months ( + 44.1%), while those ≥ 70 years showed minimal change (28.0 to 29.0 months, +3.6%). Three-year survival increased from 45.1% to 50.9% ( p = 0.004), with younger patients achieving 61.3% versus 44.0% for older patients by 2019. Multivariate Cox regression confirmed diagnosis year as an independent predictor (HR 0.96, 95% CI: 0.96–0.97, p < 0.001). Conclusions Real-world data confirm meaningful survival improvements in metastatic prostate cancer over two decades, validating the translation of clinical trial efficacy into routine practice. However, the pronounced age-related disparity suggests potential undertreatment of elderly patients and highlights the need for age-adapted treatment strategies.