Treatment patterns and outcomes in patients with nonmetastatic castration-resistant prostate cancer in the United States - Research article

Q: What was the study’s main goal for patients with nmCRPC?

To evaluate real-world treatment patterns, utilization, and survival outcomes in patients with nonmetastatic castration-resistant prostate cancer in the United States.

Q: How was the study conducted and what data source was used?

This was a retrospective cohort study using Optum database electronic health records for patients with nmCRPC from 1 January 2007 to 31 December 2020 in the US.

Q: Which treatments were most commonly used as first-line therapy?

More than 80% of patients received androgen-deprivation therapy (ADT) alone or ADT plus first-generation nonsteroidal antiandrogens (NSAAs) as first-line treatment.

Q: What did the study find about survival benefits of ADT plus NSAA versus ADT alone?

ADT plus NSAA showed no survival benefit compared with ADT alone, while ADT plus ARPI remained underutilized even among high-risk nmCRPC patients.

Sep 21, 2026

Uploaded by Skyler

Aim: Androgen receptor pathway inhibitors (ARPIs) prolong metastasis-free and overall survival in patients with nonmetastatic castration-resistant prostate cancer (nmCRPC). This retrospective cohort study assessed real-world treatment patterns, utilization, and survival outcomes for nmCRPC in the United States. Methods: Using Optum electronic health records, patients with nmCRPC were followed from 1 Jan 2007 to 31 Dec 2020. Results: Among 1,955 patients, over 80% received ADT alone or ADT plus first-generation NSAAs, while only 8.24% received ADT plus ARPI, which remained underused even in high-risk disease.

LanguageEnglish

CategoryResearch & Report

FormatPDF

Pages14

Reading Time35 min

AccessFree to download

Abstract

Background

Patients & methods

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RESEARCH ARTICLE Treatment patterns and outcomes in patients with nonmetastatic castration-resistant prostate cancer in the United States Umang Swami* , a, Agnes Hongb, Brandon Diessnerc, Christopher Youngb, Scott H Bunnerc, Bin Xieb, Krishnan Ramaswamyd, Benjamin Chastekc, Nader El Chaarb and Sumati Guptaa a Huntsman Cancer Institute, University of Utah, Salt Lake City, UT USA; bAstellas Pharma Inc., Northbrook, IL USA; cOptum, Eden Prairie, MN USA; dPﬁzer Inc., New York, NYUSA ABSTRACT Aim: Androgen receptor pathway inhibitors (ARPIs) prolong metastasis-free survival and overall survival in patients with nonmetastatic castration-resistant prostate cancer (nmCRPC) . This study aimed to evaluate real-world treatment patterns, utilization and survival outcomes in patients with nmCRPC. Patients & methods: This retrospective cohort study used Optum database electronic health records of patients with nmCRPC from 1 January 2007 to 31 December 2020 in the US. Results: Of 1955 patients, >80% received androgen-deprivation therapy (ADT) alone or ADT + firstgeneration nonsteroidal antiandrogen (NSAA) as first-line treatment, while only 8.24% received ADT + ARPI. ADT + ARPI remained underutilized even among those with high-risk nmCRPC. Further, ADT + NSAA had no survival benefit compared with ADT alone. Conclusion: Practice-improvement strategies are needed for treatment intensification with ARPIs for patients with nmCRPC. PLAIN LANGUAGE SUMMARY Prostate cancer cells often use hormones called androgens to grow and survive. Hormone therapy is a treatment that lowers the amount of these hormones in the body to slow down the cancer’s growth. It includes androgen-deprivation therapy (ADT), which can either be used alone or along with nonsteroidal antiandrogens (NSAAs) or with androgen receptor pathway inhibitors (ARPIs) . Nonmetastatic castration-resistant prostate cancer (nmCRPC) is defined as prostate cancer that has not spread to other parts of the body but exhibits rising levels of serum prostate-specific antigen despite surgery or ADT to reduce androgens. Research shows that ARPIs can improve survival inpatients with nmCRPC, but more data on its use are needed. This study looked at the electronic health records of patients with nmCRPC to review the treatment they had received and their survival. Between 2008 and 2020, most patients received ADT alone or with NSAA. Even though the number of patients receiving ADT with ARPI increased during this period, it remained underused, even inpatients with a high risk of cancer spreading to other body parts. Post-2018, even after 2 years of these drugs being available, only about one in five patients received ADT with ARPI. Also, people who received ADT with NSAA did not have a longer survival than patients treated with ADT alone. The study indicates that ARPIs, which could improve survival of patients with nmCRPC, are not being utilized optimally. Strategies that promote early use of ARPIs are needed to improve survival of patients with nmCRPC. ARTICLE HISTORY Received 18 August 2023 Accepted 25 June 2024 KEYWORDS androgen receptor pathway inhibitors; nonmetastatic castration-resistant prostate cancer; real-world data; treatment outcomes; treatment patterns; treatment utilization 1. Background Nonmetastatic castration-resistant prostate cancer (nmCRPC) was estimated to affect 112,065 men in the United States (US) in 2020, with an incidence of 58,960 cases/year [1] . It is characterized by increasing prostate-specific antigen (PSA) levels despite a castrate testosterone level (<50 ng/dl) after surgical or medical castration and without definite radiological evidence of metastases [2] . Patients with nmCRPC tend to beasymptomatic at diagnosis, with a similar health-related quality of life as age-matched cohorts from the general population [3] . High-risk nmCRPC is characterized by short PSA doubling times (PSADTs; ≤10 months) or high Gleason scores (≥8) [2,4] and

FAQs

What was the study’s main goal for patients with nmCRPC?

To evaluate real-world treatment patterns, utilization, and survival outcomes in patients with nonmetastatic castration-resistant prostate cancer in the United States.

How was the study conducted and what data source was used?

This was a retrospective cohort study using Optum database electronic health records for patients with nmCRPC from 1 January 2007 to 31 December 2020 in the US.

Which treatments were most commonly used as first-line therapy?

More than 80% of patients received androgen-deprivation therapy (ADT) alone or ADT plus first-generation nonsteroidal antiandrogens (NSAAs) as first-line treatment.

What did the study find about survival benefits of ADT plus NSAA versus ADT alone?

ADT plus NSAA showed no survival benefit compared with ADT alone, while ADT plus ARPI remained underutilized even among high-risk nmCRPC patients.

Sep 21, 2026

Uploaded by Skyler