Treatment intensification beyond androgen deprivation therapy (ADT) has shown survival benefit in patients with metastatic castration-sensitive prostate cancer (mCSPC). There is a need to better understand how these novel treatments fit in real-world practice.
Using electronic medical records and administrative data, a population-based, retrospective cohort study of patients newly diagnosed with de novo mCSPC between 2010 and 2020 in Alberta, Canada, and initiated ADT was conducted. Treatment intensification was defined as the receipt of apalutamide, abiraterone acetate, enzalutamide, or chemotherapy (e.g., docetaxel) within 180 days of ADT initiation.
A total of 2515 de novo mCSPC were identified, with 2098 (83%) patients initiating ADT post-diagnosis. Of those, 525 (25%) received intensification beyond ADT. The percentage of patients who were intensified was 3% in 2010-2013 and gradually increased to 67% in 2020. From 2014-2017, docetaxel was the most commonly used approach, although it was supplanted by abiraterone acetate, apalutamide and enzalutamide from 2018 onwards. In multivariable logistic regression analyses of patients diagnosed from 2014-2020, significant predictors of intensification were younger age at diagnosis, lower Charlson comorbidity index, greater number of metastatic sites, shorter time to ADT initiation, referral to a medical oncologist, transurethral resection of the prostate or radiation prior to ADT, and more recent year of diagnosis (all p<0.05). Intensification increased for patients living in rural areas and with higher disease burden in 2018+ compared to 2014-2017.
There has been a considerable increase in the use of ADT intensification therapies that correspond with the timing of clinical trial data and approvals of novel agents.
Canadian Urological Association journal = Journal de l'Association des urologues du Canada. 2024 Aug 30 [Epub ahead of print]
Geoffrey T Gotto, Steven M Yip, Bobby Shayegan, Dylan E O'Sullivan, Christopher J D Wallis, Naveen S Basappa, Ilias Cagiannos, Robert James Hamilton, Cristiano Ferrario, Ricardo Fernandes, Brita Danielson, Fred Saad, Sebastien J Hotte, Winson Y Cheung, Devon J Boyne, Katherine Chan, Brendan Osborne, Anousheh Zardan, Shawn Malone
Southern Alberta Institute of Urology, University of Calgary, Calgary, AB, Canada., Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada., St. Joseph's Healthcare, McMaster University, Hamilton, ON, Canada., Oncology Outcomes Initiative, University of Calgary, Calgary, AB, Canada., Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada., Cross Cancer Institute, University of Alberta, Edmonton, AB, Canada., The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada., Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada., Jewish General Hospital, McGill University, Montreal, QC, Canada., London Health Sciences Centre, Western University, London, ON, Canada., Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada., Juravinski Cancer Centre, McMaster University, Hamilton, ON, Canada., Medical Affairs, Janssen Inc, Toronto, ON, Canada.