Metastatic Castration-Sensitive Prostate Cancer (mCSPC) - Market Insight, Epidemiology And Market Forecast - 2032

DelveInsight's "Metastatic Castration-Sensitive Prostate Cancer (mCSPC)- Market Insights, Epidemiology, and Market Forecast–2032" report delivers an in-depth understanding of the mCSPC, historical and forecasted epidemiology as well as the mCSPC market trends in the United States, EU5 (Germany, Spain, Italy, France, and United Kingdom) and Japan.
The mCSPC market report provides current treatment practices, emerging drugs, mCSPC market share of the individual therapies, current and forecasted mCSPC market Size from 2019 to 2032 segmented by seven major markets. The Report also covers current mCSPC treatment practice/algorithm, market drivers, market barriers and unmet medical needs to curate best of the opportunities and assesses the underlying potential of the market.
Geography Covered
• The United States
• EU5 (Germany, France, Italy, Spain, and the United Kingdom)
• Japan
Study Period: 2019-2032

mCSPC Disease Understanding and Treatment Algorithm
Prostate cancer is a type of malignancy that occurs in the prostate gland, which is a part of male reproductive system. Prostate cancer is the 3rd most prevalent type of cancer in the US and the fourth most common worldwide. Approximately 1 in 9 men in the US will be diagnosed with prostate cancer at some point in their lives. As per American Cancer Society, 2019, prostate cancer is the second leading cause of cancer death in American men, behind only lung cancer.
Treatment options of prostate cancers include mainly hormonal therapies (also known as androgen-deprivation therapy or ADT), chemotherapy, immunotherapy, radiation therapy, and surgery. For localized or locally advanced prostate cancer has active surveillance, surgery, and radiation therapy is the 3 major treatment options.
Patients who have never received i.e. are sensitive to ADT known as hormone-sensitive prostate cancer (HSPC) or castrate-sensitive prostate cancer (CSPC).
mCSPC market is expected to witness a significant growth rate owing to rising prevalence of prostate cancer cases due to rapidly aging population and growing awareness among people, market penetration in mCSPC due to label expansion, and entry of new emerging therapies.
mCSPC Epidemiology
The mCSPC epidemiology division provides insights about historical and current mCSPC patient pool and forecasted trends for every seven major countries. It helps to recognize the causes of current and forecasted trends by exploring numerous studies and views of key opinion leaders. This part of the DelveInsight report also provides the diagnosed patient pool and their trends along with assumptions undertaken.

Key Findings
The disease epidemiology covered in the report provides historical as well as forecasted mCSPC epidemiology [segmented as total prevalent cases of prostate cancer, total diagnosed cases of prostate cancer, age-specific cases of prostate cancer, total diagnosed cases of prostate cancer by clinical stages, total metastatic cases of CSPC and total treated cases of metastatic CSPC in the 7MM covering the United States, EU5 countries (Germany, France, Italy, Spain, and the United Kingdom), and Japan from 2019 to 2032.
Country Wise mCSPC Epidemiology
Estimates show that the highest cases of mCSPC in the 7MM were in the United States, followed by Japan, Germany, the United Kingdom, Italy, France, and Spain in the year 2021.
• As per DelveInsight estimates, the total prevalent population of prostate cancer in the seven major markets was 7,726,394 cases in 2021. The cases in the 7MM are expected to increase during the study period, i.e., 2019–2032.

• As per DelveInsight estimates the diagnosed cases of prostate cancer were highest in the United States. The diagnosed cases of Prostate cancer in 2021 in the US were 1,327,642 cases.

• According to the estimated, the United States accounted for 169,647, 738,038, 1,128,665, 525,093, and 131,171 for the age group ≤ 54 years, 55-64 years, 65-74 years, 75-84 years, and >84 years in 2021.

• In EU5, the total diagnosed prevalent cases of prostate cancer by clinical stages were around 656,570, 378,363, and 77,898 cases for locally advanced (Stage I–III), biochemical recurrence/progressive, and metastatic, respectively in 2021.

• Among EU5 countries, Germany had the maximum total cases of metastatic CSPC with 14,600 cases in 2021 while Spain accounted for the least number of cases. Spain accounted for 4,381 cases of metastatic CSPC in 2021.

• As per DelveInsight estimates, treated cases of metastatic CSPC in Japan were 11,094 in 2021.

mCSPC Drug Chapters
Drug chapter segment of the mCSPC report encloses the detailed analysis of mCSPC marketed drugs and late stage (Phase-III and Phase-II) pipeline drugs. It also helps to understand the mCSPC clinical trial details, expressive pharmacological action, agreements and collaborations, approval and patent details, advantages and disadvantages of each included drug and the latest news and press releases.

Marketed Drugs
Xtandi (Pfizer)
Xtandi is an orally bioavailable, organic, non-steroidal small molecule targeting the AR with potential antineoplastic activity. Through a mechanism that is reported to be different from other approved AR antagonists, enzalutamide inhibits the activity of prostate cancer cell ARs, which may result in a reduction in prostate cancer cell proliferation and, correspondingly, a reduction in the serum PSA level. AR over-expression in prostate cancer represents a key mechanism associated with prostate cancer hormone resistance. In December 2019, Pfizer and Astellas announced that the US FDA approved a sNDA for Xtandi for the treatment of patients with mCSPC. The approval is based on results from ARCHES, a randomized phase III study which evaluated 1,150 men with mCSPC and met its primary endpoint of rPFS. In April 2021, the company announced that the EC approved an additional indication for Xtandi for adult men with mHSPC. In May 2020, the company announced that the Japanese MHLW approved the drug for the treatment of prostate cancer patients with distant metastasis.

Erleada (Janssen Pharmaceutical)
Erleada (apalutamide) is a next-generation oral AR inhibitor that blocks the androgen signaling pathway in prostate cancer cells. It is indicated for the treatment of patients with nmCRPC and for the treatment of patients with mCSPC. It is taken orally, once daily, with or without food. Erleada inhibits the growth of cancer cells in three ways: by preventing the binding of androgen to the AR; by stopping the AR from entering the cancer cells; and by preventing the AR from binding to the DNA of the cancer cell. In February 2018, Erleada received approval from the US FDA for the treatment of patients with nmCRPC. Later to that year, i.e., in September 2019, the US FDA approved Erleada for the treatment of patients with mCSPC. In January 2019, the EC granted marketing authorization for Erleada for the treatment of adult patients with nmCRPC who are at high risk of developing metastatic disease. In January 2020, the EC approved Erleada for use in combination with ADT for the treatment of adult men with mHSPC. In March 2019, Janssen obtained the MHLW approval of Erleada 60mg tablet for the treatment for adults with mCRPC. In May 2020, Nippon Shinyaku announced that Janssen Pharmaceutical which is the marketing authorization holder of the drug has obtained an expanded approval for the treatment of men with prostate cancer with distant metastases from the Ministry of Health, Labor and Welfare (MHLW).

Orgovyx (Myovant Sciences)
Orgovyx (relugolix) is a small molecule, gonadotropin-releasing hormone (GnRH) receptor antagonist, and an oral investigational drug candidate for the treatment of advanced prostate cancer. As a GnRH receptor antagonist, relugolix binds to and blocks the GnRH receptor (GnRHR) in the anterior pituitary gland. Blocking GnRH receptors decreases the release of gonadotropins – luteinizing hormone (LH) and follicle-stimulating hormone (FSH) – thereby decreasing the downstream production of estrogen and progesterone by the ovaries in women and testosterone by the testes in men. Myovant is developing relugolix 120 mg following a single 360 mg loading dose as a monotherapy, investigating whether this monotherapy decreases testosterone to low levels. Takeda has granted Myovant an exclusive, worldwide license (excluding Japan and certain other Asian countries) to relugolix. In December 2020 the company announced that the FDA approved relugolix for the treatment of adults with advanced prostate cancer. EC decision on the advanced prostate cancer MAA is expected in calendar year 2022

Note: Detailed Current therapies assessment will be provided in the full report of mCSPC

mCSPC Emerging Drugs
Drug chapter segment of the mCSPC report encloses the detailed analysis of mCSPC marketed drugs and late stage (Phase-III and Phase-II) pipeline drugs. It also helps to understand the mCSPC clinical trial details, expressive pharmacological action, agreements and collaborations, approval and patent details, advantages and disadvantages of each included drug and the latest news and press releases.

Talazoparib (Pfizer)
Talazoparib is an inhibitor of PARP enzymes, which play a role in DNA response. Preclinical studies have demonstrated that talazoparib blocks PARP enzyme activity and traps PARP at the site of DNA damage, leading to decreased cancer cell growth and cancer cell death. Talazoparib is being evaluated in several ongoing clinical trials in prostate cancer, as well as other novel combinations with targeted therapies in various solid tumors. With the introduction of PARP inhibitors in the mCRPC setting, it is important to explore how a combination approach may impact outcomes for men with the metastatic castration-sensitive disease. The company also anticipated that the prognosis for men with advanced prostate cancer has significantly improved since the introduction of novel hormone therapies, but additional therapeutic options are needed for the approximately 25 percent of men with tumors harboring DNA damage response (DDR) gene mutations, who may have poorer outcomes. Combining enzalutamide – which has a proven clinical benefit in men with mCSPC – with talazoparib – active in DDR-mutated cancer – may offer a new treatment that targets the underlying genetic mechanisms associated with DDR-mutated mCSPC.

Nubeqa (Bayer)
Nubeqa (darolutamide) is an oral ARi with a distinct chemical structure that binds to the receptor with high affinity and exhibits strong antagonistic activity, thereby inhibiting the receptor function and the growth of prostate cancer cells. The compound is also being investigated in a Phase III study in mHSPC (ARASENS). Nubeqa is currently indicated for treating patients with nmCRPC. Darolutamide is approved under the brand name Nubeqa in several markets around the world, including the US, the EU, Brazil, Canada, Japan, and China, for the treatment of men with nmCRPC, who are at high risk of developing metastatic disease.

Keytruda (Merck Sharp & Dohme)
Keytruda, also known as pembrolizumab, is a PD-1 blocking antibody. It is mainly used for advanced cancers, have spread to other parts of the body or are not responding to other treatments. In some cancers, it is only given to patients whose tumors produce high levels of a protein known as PD-L1. It is approved for multiple types of cancer. This is currently being investigated in phase III clinical trial in combination with enzalutamide to treat patients affected by mHSPC.

Niraparib (Janssen)
Niraparib is an orally-administered selective PARP inhibitor that is currently being studied by Janssen for the treatment of patients with metastatic castration-resistant prostate cancer and BRCA1/2 DNA repair gene defects. Ongoing studies include the Phase III AMPLITUDE study evaluating Niraparib in combination with abiraterone acetate plus prednisone in a biomarker-selected patient population with mHSPC and the Phase III MAGNITUDE study evaluating Niraparib in combination with abiraterone acetate plus prednisone in adults with mCRPC. In the US, Niraparib is indicated for the maintenance treatment of adult patients with recurrent epithelial ovarian, fallopian tube, or primary peritoneal cancer who are in complete or partial response to platinum-based chemotherapy. Niraparib is currently marketed as Zejula by Tesaro, an oncology-focused business within GSK devoted to providing transformative therapies to people facing cancer

Rubraca (Clovis Oncology)
Clovis Oncology is investigating one of their lead candidates named Rubraca (Rucaparib) for various cancer indications. It is an oral, small-molecule inhibitor of PARP1, PARP2, and PARP3 being developed in prostate cancer and ovarian cancer and several additional solid tumor indications. Upon administration, rucaparib selectively binds to PARP-1, PARP-2, and PARP-3 and inhibits PARP1-mediated repair of ssDNA breaks via the base-excision repair pathway. This enhances the accumulation of DNA strand breaks and promotes genomic instability and apoptosis. Rucaparib may potentiate the cytotoxicity of DNA damaging agents and reverse tumor cell resistance to chemotherapy and radiation therapy. PARP catalyzes post-translational ADP-ribosylation of nuclear proteins and is activated by ssDNA breaks. Rubraca is the first PARP inhibitor approved in a prostate cancer setting. As per the press release, the company has also anticipated that three top-line Phase III data read-outs for Rubraca are expected in 2022, with the potential to address larger ovarian and prostate cancer patient populations in earlier lines of therapy.

Other products in development include Opdivo (nivolumab) by Bristol-Myers Squibb, Capivasertib by AstraZeneca, 177Lu-PSMA-617 by Novartis, Firmagon (Degarelix) by Ferring Pharmaceuticals, Tecentriq (Atezolizumab) by Genentech, and Cabometyx (Cabozantinib): Exelixis/ Bristol-Myers Squibb.

Note: Detailed emerging therapies assessment will be provided in the final report.

mCSPC Market Outlook
mCSPC, also referred to as mHSPC in literature refers to prostate cancer that still responds to testosterone suppression therapy. Moreover, patients with newly diagnosed metastatic disease and high-risk disease characteristics tend to have a poorer prognosis.
• In 2018, Zytiga (abiraterone acetate) in combination with prednisone was approved for the treatment of metastatic high-risk CSPC. Approval in this category was based on the results of the Phase III LATITUDE trial. Before this, Zytiga was approved in 2011 initially for patients with mCRPC who had received prior chemotherapy and expanded the indication in 2012 for patients with mCRPC.
• Moreover, In September 2019, the US FDA also approved Erleada for patients with mHSPC. The efficacy of Erleada was evaluated in TITAN Trial. The findings of this trial have shown statistically significant improvements in both OS and rPFS. At the time of a prespecified interim analysis, the hazard ratio for overall survival was 0.67, and median overall survival was not reached in either arm. The hazard ratio for the rPFS improvement was 0.48. The median rPFS was not reached with apalutamide plus ADT and was 22.1 months with placebo plus ADT.
• With this approval, Janssen has strengthened its spot in the prostate cancer drug market. In contrast, drugs like Zytiga have started facing generic competition from the past few years. Approval of Erleada for mCSPC has put a barrier to the growth of the sales of Zytiga, which is already facing competition.
• In December 2019, the US FDA approved Xtandi for patients with mCSPC. Prior to this, the US FDA approved Xtandi for patients with CRPC. With this approval, Xtandi became first and only oral treatment approved by the US FDA in three distinct types of advanced prostate cancer—nonmetastatic and CRPC and mCSPC. The efficacy of Xtandi was investigated in the ARCHES trial (NCT02677896). All enrolled patients received a GnRH analog or had a prior bilateral orchiectomy. In this study, the main efficacy endpoint was rPFS. However, median rPFS was not reached in the Xtandi arm compared to 19.4 months in the placebo arm. However, a significant improvement reported on the Xtandi arm compared to placebo in time to initiation of a new antineoplastic therapy. The use of Xtandi plus ADT significantly reduced the risk of radiographic progression or death by 61% compared to placebo plus ADT. At the time of rPFS analysis of this drug, OS data was not established. This approval had put direct competition between Zytiga and Xtandi. Besides, it is anticipated that in coming years, both drugs could hold a considerable market share for mCSPC/HSPC treatment paradigm.
• In December 2020, Orgovyx – a small molecule, GnRH receptor antagonist was approved for the treatment of advanced prostate cancer. The US FDA approval was based on Phase III HERO clinical trial evaluating relugolix as a monotherapy in men with advanced prostate cancer. In November 2019, company announced that Phase III HERO study of once-daily, oral relugolix met its primary efficacy endpoint and all six key secondary endpoints in men with advanced prostate cancer. Company also anticipates future regulatory submissions in Europe and Japan.
From the past few years, improvements in the field of prostate cancer have shown that treatments are more effective when used early. However, combination therapy has yet to be proven beneficial. In order to achieve that, it is necessary to possess a profound understanding of the market, and the associated unmet needs. Reflecting on these issues, the significance of dedicating resources on R&D is also imperative. Moreover, to achieve significant success in mHSPC pricing, policies must be considered, because this further will help in the launch of a product that is truly attractive and appropriate to the market, where it is launched. All these factors help in building a strong product-market fit.
The mCSPC pipeline possesses drugs in the late-stage development, many of which hold the potential to get launched in the forecast period. The key players include Bayer (Nubeqa), Merck Sharp & Dohme (Keytruda/), Pfizer (Talazoparib), Janssen (Niraparib), Clovis Oncology (Rubraca), Bristol-Myers Squibb (Opdivo), AstraZeneca (Capivasertib), Novartis (177Lu-PSMA-617), and others investigating their candidates for the treatment of mCSPC in the 7MM.
According to DelveInsight, mCSPC market in 7MM is expected to witness a major change in the study period 2019-2032.

Key Findings
• The market size of mCSPC in the seven major markets is expected to rise from USD 679.1million in 2021 during the study period (2019–2032).
• The therapies with the potential to get launched in the forecast period include Bayer (Nubeqa), Merck Sharp & Dohme (Keytruda), Pfizer (Talazoparib), Janssen (Niraparib), Clovis Oncology (Rubraca), Bristol-Myers Squibb (Opdivo), AstraZeneca (Capivasertib), Novartis (177Lu-PSMA-617), and others. The launch of these therapies may increase market size in the coming years, assisted by an increasing patient pool of mCSPC patients.
• The United States accounts for the largest market size of mCSPC compared to EU5 (Germany, the United Kingdom, Italy, France, and Spain) and Japan.
• In the United States, the market size of mCSPC is anticipated to rise from USD 502.7 million in 2021 during the forecast period.
• Among the EU5 countries, Germany had the largest market size (USD 49.1 million) in 2021, while Spain had the smallest with USD 14.3 million.
• In 2021, Japan accounted for a market size of USD 35.6 million.

The United States Market Outlook
The total market size of mCSPC in the United States is expected to increase with a CAGR of 25.8% in the study period (2019–2032).
EU-5 Countries: Market Outlook
The total market size of mCSPC in EU5 is expected to increase with a CAGR of 31.1% in the study period (2019–2032).
Japan Market Outlook
The total market size of mCSPC in the Japan is expected to increase with a CAGR of 28.8% in the study period (2019–2032).
Analyst Commentary
• Most of the attention in the field of advanced prostate cancer was restricted to the research and development of drugs for patients with CRPC even though CSPC is burdened with poor prognosis and impaired quality of life. However, recent years have witnessed an expansion in the field of mCSPC which led to approval of a handful of drugs for this patient pool. Owing to handful of drugs approved in this field, the market poses an opportunity for the upcoming drugs. Any medication, if approved, may capture a major share of the market due to less competitive scenario.
• According to secondary source, chemotherapy usage is higher in EU, incomparison to the US and Japan. In Japan, less chemotherapy usage is observed.
• Many drugs can be used in the treatment algorithm for mCSPC, but the standard of care continues to be androgen deprivation therapy with either docetaxel, enzalutamide (Xtandi), apalutamide (Erleada), or abiraterone acetate (Zytiga. Additionally, darolutamide (Nubeqa) could potentially be added to this treatment. The established markets of the already approved drugs may provide a fair competition to the upcoming therapies.
• For decades, the SOC for mCSPC has been ADT. Although it is initially effective in most of the patient population, eventually, the disease progresses and develops castration resistance; this occurs at a median time of approximately 1 year. Our analysis suggest that intensifying ADT with additional agents, specifically docetaxel or androgen receptor pathway inhibitors has improved PFS and OS. Thus, the market possess a void and potential opportunity for development of treatment options as monotherapy or combination therapies to provide PFS to this patient pool.
• Our analysis suggests that prostate cancers with HRR gene alterations are more aggressive. These alterations are augmented in patients with metastatic disease and respond very well to PARP inhibitors. Although the efficacy of PARP inhibitors has been established in patients with metastatic castration-resistant prostate cancer in previous studies, the use of these agents earlier on in the disease process has yet to be evaluated. Trials such Phase III AMPLITUDE trial evaluating the use of standard ADT plus Zytiga and prednisone with or without the PARP inhibitor Zejula in patients with HRR gene–mutated mCSPC might address this knowledge gap. We believe that these agents may provide clinical benefits in this patient pool.
• We believe that Orgovyx (Relugolix) holds the potential to address the unmet needs in the field. The drug may prove to be a blockbuster considering the scarcity of approved therapy for mCSPC patients, provided that the drug demonstrates promising efficacy and safety data in the ongoing trial.
• Other therapies Nubeqa (darolutamide) + ADT ± docetaxel and Capivasertib + Abiraterone: PTEN deficient have the potential to change the market dynamics. The anticipation is based on the recent data presented by the companies.
• According to our analysis, Orgovyx (Relugolix) has the potential to grab a major patient pool during the forecast period. The oral route of administration and the company’s visibility around the product may set the drug for approval by 2022 by EMA, and PMDA by 2023. The drug’s potential is attributed to the strong safety and efficacy demonstrated by the drug during the clinical development activity.
• Although the current pipeline landscape is not robust, the entry of pharmaceutical firms exploring novel medicines for mCSPC/mHSPC in the future label extension of currently approved medications can contribute to the overall market size.
• To summarize, various possible treatments for the management of mCSPC will be researched in the near future, and it is safe to expect that the therapeutic space will suffer substantial influence throughout the forecast period, 2022–2032.

mCSPC Drugs Uptake
This section focusses on the rate of uptake of the potential drugs recently launched in the mCSPC market or expected to get launched in the market during the study period 2019-2032. The analysis covers mCSPC market uptake by drugs; patient uptake by therapies; and sales of each drug. For example-

Nubeqa (darolutamide) Based on the key Phase III ARAMIS trial findings, Nubeqa was approved in the United States in 2019 for the treatment of patients with nmCRPC. According to the company, strong launch performance has been observed in men with high-risk nmCRPC to date. Nubeqa has made significant advances, owing to increased volumes in the United States. The company is also experiencing promising early signs in Europe. So far, the price and reimbursement environment in Germany has been positive. In Germany, it is the only second-generation ARi to receive significant benefits from IQWIG and GB-A. Finally, a good market share increase in nmCRPC, along with a sustained rise in new prescribers and favorable consumer opinion, will encourage continued acceptance of this candidate in the United States and other countries as well. In males with mHSPC, a Phase III ARASENS study recently met the primary endpoint of OS for Nubeqa + docetaxel + ADT. ARASENS is part of a larger Nubeqa development package that involves another ongoing Phase III study in mHSPC, ARANOTE, which is evaluating Nubeqa + ADT. Bayer intends to disclose these significant findings at an upcoming scientific conference and to discuss them with health officials. Given the optimistic results from the Phase III mCSPC trial and robust performance of Nubeqa in nmCRPC so far, it is reasonable to expect that Nubeqa's potential in men with metastatic HSPC will provide a new therapeutic alternative. It is expected that the drug may enter the US market in 2022 and the EU and Japanese market in 2023.

Note: Detailed emerging therapies assessment will be provided in the final report.

mCSPC Pipeline Development Activities
The report provides insights into different therapeutic candidates in Phase II and Phase III stage. It also analyses mCSPC key players involved in developing targeted therapeutics.
Pipeline Development Activities
The report covers the detailed information of collaborations, acquisition and merger, licensing, patent details and other information for mCSPC emerging therapies.
Reimbursement Scenario in mCSPC
• Pfizer and Astellas are committed to helping patients access Xtandi by providing them with access and reimbursement support resources, including information regarding patient healthcare coverage options and financial assistance options that may be available to help patients with financial needs. The Xtandi Patient Savings Program is for eligible patients with commercial prescription insurance. The Astellas Patient Assistance Program provides Xtandi at no cost to patients who meet the program eligibility requirements. All patients in this program who qualify receive their Xtandi prescription at no cost.
• To comfort mHSPC patients, Janssen has initiated support for patients using commercial or private insurance to pay for medication. Janssen CarePath Savings Program for Erleada can help eligible patients receive instant savings on their out-of-pocket medication costs for Erleada. Depending on the patient’s health insurance plan, savings may apply toward co-pay, co-insurance, or deductible. Eligible patients will pay USD 0 per month with a USD 15,000 maximum program benefit per calendar year or one-year supply, whichever comes first (Janssen). Further, the Janssen CarePath Savings Program for Zytiga aims to help eligible patients receive instant savings on their out-of-pocket medication costs for Zytiga. Depending on the patient’s health insurance plan, savings may apply toward co-pay, co-insurance, or deductible.
KOL- Views
To keep up with current market trends, we take KOLs and SME's opinion working in the domain through primary research to fill the data gaps and validate our secondary research. Some of the leaders are Senior Vice President and Head of Oncology Development, Bayer Pharmaceuticals, – M.D. and Professor, University of Utah School of Medicine and others. Their opinion helps to understand and validate current and emerging therapies treatment patterns or mCSPC market trend. This will support the clients in potential upcoming novel treatment by identifying the overall scenario of the market and the unmet needs.
Competitive Intelligence Analysis
We perform Competitive and Market Intelligence analysis of the mCSPC Market by using various Competitive Intelligence tools that include - SWOT analysis, PESTLE analysis, Porter's five forces, BCG Matrix, Market entry strategies etc. The inclusion of the analysis entirely depends upon the data availability.
Scope of the Report
• The report covers the descriptive overview of mCSPC, explaining its causes, signs and symptoms, pathophysiology, diagnosis and currently available therapies
• Comprehensive insight has been provided into the mCSPC epidemiology and treatment in the 7MM
• Additionally, an all-inclusive account of both the current and emerging therapies for mCSPC are provided, along with the assessment of new therapies, which will have an impact on the current treatment landscape
• A detailed review of mCSPC market; historical and forecasted is included in the report, covering drug outreach in the 7MM
• The report provides an edge while developing business strategies, by understanding trends shaping and driving the global mCSPC market
Report Highlights
• In the coming years, mCSPC market is set to change due to the rising awareness of the disease, and incremental healthcare spending across the world; which would expand the size of the market to enable the drug manufacturers to penetrate more into the market
• The companies and academics are working to assess challenges and seek opportunities that could influence mCSPC R&D. The therapies under development are focused on novel approaches to treat/improve the disease condition
• Major players are involved in developing therapies for mCSPC. Launch of emerging therapies will significantly impact the mCSPC market
• A better understanding of disease pathogenesis will also contribute to the development of novel therapeutics for mCSPC
• Our in-depth analysis of the pipeline assets across different stages of development (Phase III and Phase II), different emerging trends and comparative analysis of pipeline products with detailed clinical profiles, key cross-competition, launch date along with product development activities will support the clients in the decision-making process regarding their therapeutic portfolio by identifying the overall scenario of the research and development activities
mCSPC Report Insights
• Patient Population
• Therapeutic Approaches
• mCSPC Pipeline Analysis
• mCSPC Market Size and Trends
• Market Opportunities
• Impact of upcoming Therapies

mCSPC Report Key Strengths
• 11 Years Forecast
• 7MM Coverage
• mCSPC Epidemiology Segmentation
• Key Cross Competition
• Highly Analyzed Market
• Drugs Uptake

mCSPC Report Assessment
• Current Treatment Practices
• Unmet Needs
• Pipeline Product Profiles
• Market Attractiveness
• Market Drivers and Barriers

Key Questions
Market Insights:
• What was the mCSPC drug class share (%) distribution in 2019 and how it would look like in 2032?
• What would be the mCSPC total market size as well as market size by therapies across the 7MM during the forecast period (2019-2032)?
• What are the key findings pertaining to the market across 7MM and which country will have the largest mCSPC market size during the forecast period (2019-2032)?
• At what CAGR, the mCSPC market is expected to grow in 7MM during the forecast period (2019-2032)?
• What would be the mCSPC market outlook across the 7MM during the forecast period (2019-2032)?
• What would be the mCSPC market growth till 2032, and what will be the resultant market Size in the year 2032?
• How would the unmet needs affect the market dynamics and subsequent analysis of the associated trends?


1 Key Insights
2 Report Introduction
3 Metastatic Castration-Sensitive Prostate Cancer (mCSPC) Market Overview at a Glance
3.1 Market Share (%) Distribution of Metastatic Castration-Sensitive Prostate Cancer (mCSPC) in 2022
3.2 Market Share (%) Distribution of Metastatic Castration-Sensitive Prostate Cancer (mCSPC) in 2032
4 Executive Summary of Metastatic Castration-Sensitive Prostate Cancer (mCSPC)
5 Key Events
6 Epidemiology and Market Forecast Methodology
7 SWOT Analysis
8 Disease Background and Overview
8.1.1 Signs and Symptoms of Prostate Cancer
8.1.2 Risk Factors and Causes of Prostate Cancer
8.1.3 Pathophysiology of Prostate Cancer
8.1.4 Prostate Neoplasia
8.1.5 Genetics of Prostate Cancer
9 Diagnosis of Prostate Cancer
9.1.1 Screening Tests for Prostate Cancer
9.1.2 Tests to Diagnose Prostate Cancer
9.1.3 Stages and Grades of Prostate Cancer
10 Treatment and Management of Prostate Cancer
10.1 Treatment Algorithm of Prostate Cancer
10.2 Observation or Active Surveillance
10.3 Surgery
10.3.1 Open or Laparoscopic Radical Prostatectomy
10.3.2 Risks of Prostate Surgery
10.4 Radiation Therapy
10.4.1 Types of Radiation Therapy
10.5 Hormone Therapy
10.5.1 Types of Hormone Therapy
10.6 Immunotherapy
10.6.1 Vaccine
10.6.2 Immune checkpoint inhibitors
10.7 Chemotherapy
11 American Urological Association (AUA) Guidelines for mHSPC: 2020
12 Guidelines for mHSPC: Abiraterone acetate combined with castration is another standard (European Association of Urology, 2018)
13 National Institute for health and care excellence (NICE) Recommendation Guidelines for mCSPC/mHSPC: 2022
14 SEOM Clinical Guidelines for mCSPC/mHNPC: 2021
15 Updated NCCN Guidelines for mCSPC
16 Epidemiology and Patient Population
16.1 Key Findings
16.2 Total Prevalent Cases of Prostate Cancer in the 7MM
16.3 Total Diagnosed Cases of Prostate Cancer in the 7MM
16.4 Total Metastatic Cases of CSPC/HSPC in the 7MM
16.5 Total Treated Cases of Metastatic CSPC/HSPC in the 7MM
16.6 Assumptions and Rationale
16.7 The United States
16.7.1 Total Diagnosed Cases of Prostate Cancer in the United States
16.7.2 Age-specific Cases of Prostate Cancer in the United States
16.7.3 Total Diagnosed Cases of Prostate Cancer by Clinical Stages in the United States
16.7.4 Total Metastatic Cases of CSPC/HSPC in the United States
16.7.5 Total Treated Cases of Metastatic CSPC/HSPC in the United States
16.8 EU-5 Epidemiology
16.8.1 Total Diagnosed Prevalent cases of Prostate Cancer in EU5
16.8.2 Age-specific Diagnosed Prevalent Cases of Prostate Cancer in EU5
16.8.3 Total Diagnosed Prevalent cases of Prostate Cancer by Clinical Stages in EU5
16.8.4 Total Metastatic Cases of CSPC/HSPC in EU5
16.8.5 Total Treated Cases of Metastatic CSPC/HSPC in EU5
16.9 Japan
16.9.1 Total Diagnosed Prevalent cases of Prostate Cancer in Japan
16.9.2 Age-specific Diagnosed Prevalent cases of Prostate Cancer in Japan
16.9.3 Total Diagnosed Prevalent cases of Prostate Cancer by Clinical Stages in Japan
16.9.4 Total Metastatic Cases of CSPC/HSPC in Japan
16.9.5 Total Treated Cases of Metastatic CSPC/HSPC in Japan
17 Organizations contributing towards Metastatic Castration-Sensitive Prostate Cancer (mCSPC)
18 Marketed Therapies
18.1 Key Competitors
18.2 Xtandi (enzalutamide): Astellas Pharma/Pfizer
18.2.1 Product Description
18.2.2 Regulatory Milestones
18.2.3 Other Developmental Activities
18.2.4 Clinical Development activity
18.2.5 Safety and Efficacy
18.3 Erleada (apalutamide): Janssen Pharmaceutical
18.3.1 Product Description
18.3.2 Regulatory Milestones
18.3.3 Other Developmental Activities
18.3.4 Clinical Development activity
18.3.5 Safety and Efficacy
18.4 Orgovyx (relugolix): Myovant Sciences/Takeda
18.4.1 Product Description
18.4.2 Regulatory Milestones
18.4.3 Clinical Development activity
18.4.4 Safety and Efficacy
19 Emerging Therapies
19.1 Key Competitors
19.2 Emerging Drugs
19.2.1 Nubeqa (Darolutamide): Bayer
19.2.2 Keytruda (Pembrolizumab/MK-3475): Merck Sharp & Dohme
19.2.3 Talazoparib: Pfizer
19.2.4 Niraparib: Janssen
19.2.5 Rubraca (Rucaparib): Clovis Oncology
19.2.6 Opdivo (Nivolumab): Bristol-Myers Squibb
19.2.7 Capivasertib (AZD 5363): AstraZeneca
19.2.8 177Lu-PSMA-617: Novartis Pharmaceuticals
19.2.9 Firmagon (Degarelix): Ferring Pharmaceuticals
19.2.10 Tecentriq (Atezolizumab): Genentech
19.2.11 Cabometyx (Cabozantinib): Exelixis/ Bristol-Myers Squibb
20 Metastatic Castration-Sensitive Prostate Cancer (mCSPC): Seven Major Market Analysis
20.1 Key Findings
20.2 Total Market Size of MHSPC/mCSPC in the 7MM
20.3 Market Size of MHSPC/mCSPC by therapies in the 7MM
20.4 Market Outlook
20.5 Key Market Forecast Assumptions
20.6 United States Market Size
20.6.1 Total Market Size of mHSPC/mCSPC in the United States
20.6.2 Market Size of MHSPC/mCSPC by Therapies in the United States
20.7 EU-5 Market Size
20.7.1 Total Market size of mHSPC/mCSPC in EU5
20.7.2 Market Size of mHSPC/mCSPC by Therapies in EU5
20.8 Japan
20.8.1 Total Market size of mHSPC/mCSPC in Japan
20.8.2 Market Size of mHSPC/mCSPC by Therapies in Japan
21 Market Drivers
22 Market Barriers
23 Unmet Needs
24 Reimbursement and Market Access
25 Appendix
25.1 Bibliography
26 Report Methodology
27 DelveInsight Capabilities
28 Disclaimer
29 About DelveInsight
Table 1: Summary of Metastatic Castration-Sensitive Prostate Cancer (mCSPC) Market, and Epidemiology (2019–2032)
Table 2: Key Events
Table 3: Genetic Changes Associated with Prostate Cancer Tumorigenesis
Table 4: New guidelines to Consider for Metastatic Hormone-sensitive Prostate Cancer
Table 5: Total Prevalent Cases of Prostate Cancer in the 7MM
Table 6: Total Diagnosed Cases of Prostate Cancer in the 7MM
Table 7: Total Diagnosed Prevalent Cases of mCSPC/mHSPC in the 7MM
Table 8: Total Treated Cases of mHSPC/mCSPC in the 7MM
Table 9: Total Diagnosed Cases of Prostate Cancer in the United States
Table 10: Age-specific Cases of Prostate Cancer in the United States
Table 11: Total Diagnosed Cases of Prostate Cancer by Clinical Stages in the US
Table 12: Total Diagnosed Prevalent Cases of mCSPC/mHSPC in the United States
Table 13: Total Treated Cases of mHSPC/mCSPC in the United States
Table 14: Total Diagnosed Prevalent Population of Prostate Cancer in EU5
Table 15: Age-specific Diagnosed Prevalent Cases of Prostate Cancer in EU5
Table 16: Total Diagnosed Prevalent cases of Prostate Cancer by Clinical Stages in EU5
Table 17 Total Diagnosed Prevalent Cases of mCSPC/mHSPC in EU5
Table 18: Total Treated Cases of Metastatic CSPC/HSPC in EU5
Table 19: Total Diagnosed Prevalent cases of Prostate Cancer in Japan
Table 20: Age-specific Diagnosed Prevalent cases of Prostate Cancer in Japan
Table 21: Total Diagnosed Prevalent Cases of Prostate Cancer by Clinical Stages in Japan
Table 22: Total Diagnosed Prevalent Cases of mCSPC/mHSPC in Japan
Table 23:Total Treated Cases of Metastatic CSPC/HSPC in Japan
Table 24: Organizations Contributing Toward the Fight Against Metastatic Hormone-Sensitive Prostate Cancer
Table 25: Comparison of Marketed drugs
Table 26: Xtandi, Clinical Trial Description, 2022
Table 27: Erleada, Clinical Trial Description, 2022
Table 28: Relugolix, Clinical Trial Description, 2022
Table 29: Comparison of emerging drugs under development
Table 30: Nubeqa, Clinical Trial Description, 2022
Table 31:Keytruda, Clinical Trial Description, 2022
Table 32: Market Size of MHSPC/mCSPC in the 7MM in USD Million
Table 33: Market Size of MHSPC/mCSPC by Therapies in the 7MM in USD Million
Table 34: Key Market Forecast Assumptions for Nubeqa (Darolutamide)
Table 35: Key Market Forecast Assumptions for Talazoparib
Table 36: Key Market Forecast Assumptions for Niraparib
Table 37: Key Market Forecast Assumptions for Rubraca (Rucaparib)
Table 38: Key Market Forecast Assumptions for Capivasertib (AZD 5363)
Table 39: Key Market Forecast Assumptions for 177Lu-PSMA-617
Table 40: Key Market Forecast Assumptions for Keytruda (Pembrolizumab)
Table 41: Key Market Forecast Assumptions for Opdivo
Table 42: Market Size of mHSPC/mCSPC in the US, USD Million
Table 43: Market Size of MHSPC/mCSPC by Therapies in the US, USD Million
Table 44: EU5 Market Size of mHSPC/mCSPC in USD Million
Table 45: EU5 Market Size of mHSPC/mCSPC by Therapies in USD Million
Table 46: Japan Market Size of mHSPC/mCSPC in Japan, USD Million
Table 47: Market Size of mHSPC/mCSPC by Therapies in Japan, USD Million
Table 48: National Institute for Health and Care Excellence (NICE) Decisions for mHSPC Therapies
Table 49: Haute Autorité de santé (HAS) Decisions for mHSPC Therapies
Table 50: IQWiG Decisions for mHSPC TherapiesFigure 1: Prostate Cancer
Figure 2: Sign and Symptoms of Prostate Cancer
Figure 3: Risks Factors of Prostate Cancer
Figure 4: Pathophysiology of Prostate Cancer
Figure 5: Progression of Prostate Cancer and the Development of mCRPC
Figure 6: Diagnosis of Prostate Cancer
Figure 7: Gleason Score of Prostate Cancer
Figure 8: Localized Disease Treatment Algorithm
Figure 9: High-risk Localized and Locally Advanced Disease Treatment Algorithm
Figure 10: Metastatic Disease Treatment Algorithm
Figure 11: Suggested Treatment Paradigm for Molecular Biomarkers in Advanced Prostate Cancer
Figure 12: Total Prevalent Cases of Prostate Cancer in the 7MM
Figure 13: Total Diagnosed Cases of Prostate Cancer in the 7MM
Figure 14: Total Diagnosed Prevalent Cases of mCSPC/mHSPC in the 7MM
Figure 15: Total Treated Cases of mHSPC/mCSPC in the 7MM
Figure 16: Global Heat Map of Prostate Cancer
Figure 17: Total Diagnosed Cases of Prostate Cancer in the United States
Figure 18: Age-specific Cases of Prostate Cancer in the United States
Figure 19: Total Diagnosed Cases of Prostate Cancer by Clinical Stages in the US
Figure 20: Total Diagnosed Prevalent Cases of mCSPC/mHSPC in the United States
Figure 21: Total Treated Cases of mHSPC/mCSPC in the United States
Figure 22: Total Diagnosed Prevalent Cases of Prostate Cancer in EU5
Figure 23: Age-specific Diagnosed Prevalent Cases of Prostate Cancer in EU5
Figure 24: Total Diagnosed Prevalent cases of Prostate Cancer by Clinical Stages in EU5
Figure 25: Total Diagnosed Prevalent Cases of mCSPC/mHSPC in EU5
Figure 26: Total Treated Cases of Metastatic CSPC/HSPC in EU5
Figure 27: Total Diagnosed Cases of Prostate Cancer in Japan
Figure 28: Age-specific Diagnosed Prevalent cases of Prostate Cancer in Japan
Figure 29: Total Diagnosed Prevalent Cases of Prostate Cancer by Clinical Stages in Japan
Figure 30: Total Diagnosed Prevalent Cases of mCSPC/mHSPC in Japan
Figure 31: Total Treated Cases of Metastatic CSPC/HSPC in Japan
Figure 32: Market Size of MHSPC/mCSPC in the 7MM in USD Million
Figure 33: Market Size of MHSPC/mCSPC by Therapies in the 7MM in USD Million
Figure 34: Market Size of mHSPC/mCSPC in the US, USD Millions
Figure 35: Market Size of MHSPC/mCSPC by Therapies in the US, USD Million
Figure 36: Market Size of mHSPC/mCSPC in EU5, USD Million
Figure 37: EU5 Market Size of mHSPC/mCSPC by Therapies in USD Million
Figure 38: Market Size of mHSPC/mCSPC in Japan, USD Million
Figure 39: Japan Market Size of mHSPC/mCSPC by Therapies, USD Million

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