At the same time, earlier detection of metastatic disease has led to lower tumor burden in patients with de novo mCSPC, as mirrored by lower prostate-specific antigen (PSA) levels at diagnosis.14 The aim of this study was to investigate if the increased use of doublet therapy in men with de novo mCSPC in Sweden has been accompanied by improvements in survival, taking other temporal changes into consideration. This evidence concerns the gene KLK3 and metastatic neoplasm.