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2025 The John Black Charitable Foundation – PCF Young Investigator Award

Real-world Evaluation of Advanced, Late-stage Metastatic Prostate Cancer (REALM)

Pawel Rajwa, MD       
University College London (UCL) 

Mentors: Veeru Kasiviswanathan, James N’Dow, Shahrokh Shariat

Description:

  • The advent of modern systemic therapies, particularly in the metastatic hormone-sensitive prostate cancer (mHSPC) setting, has revolutionized treatment, demonstrating a significant improvement in survival when androgen deprivation therapy is combined with androgen receptor pathway inhibitors with or without docetaxel. 
  • However, the real-world effectiveness and toxicity profiles of combination therapies remain underexplored, particularly for patients who are older and/or have comorbidities, who may not be represented in randomized controlled trials. Large-scale real-world data has the potential to bridge this gap by providing insights into treatment implementation, effectiveness, and toxicity across diverse populations. 
  • Dr. Pawel Rajwa aims to evaluate the real-world effectiveness, toxicity profiles, and treatment patterns of modern systemic therapies for patients with mHSPC. 
  • In this project, Dr. Rajwa will create “REALM,” a large real-world project, by standardizing over 20 international datasets which include hospital electronic health records, insurance claims, and patient registries from the United States and Europe. Collectively, this will represent over 100,000 patients with mHSPC who received therapy from 2024 and earlier.
  • Using this dataset, Dr. Rajwa will analyze the incidence, patterns, and significance of adverse events associated with modern systemic therapies in patients with mHSPC, with a focus on differences across target populations.  The implementation and clinical outcomes of modern systemic therapies will be evaluated in patients with mHSPC by analyzing treatment patterns, patient characteristics, and survival-related factors across diverse datasets and populations in the USA and Europe. Finally, insights from this study will be used to support a prospective global prostate cancer registry, to enable continued research and aid clinicians in bridging the gap between best practices and real-world clinical practice.
  • If successful, this project will provide the most comprehensive real-world assessment of modern systemic therapies in mHSPC to date, contributing to the development of a prospective global prostate cancer registry, aiming to monitor and improve guideline-based care implementation worldwide. 

What this means to patients: Due to advances in medical research, there are now several treatment options available for patients with metastatic hormone-sensitive prostate cancer (mHSPC); however real-world treatment patterns, treatment effectiveness and toxicity remain unclear. Dr. Rajwa’s project will evaluate international real-world datasets representing over 100,000 patients to answer these questions. By integrating real-world data into clinical decision-making, this project has the potential to transform advanced prostate cancer management, personalize treatment, improve outcomes, and reduce disparities in care.