Hormonal treatment for newly diagnosed metastatic prostate cancer: A population-based study of 15,435 cases from the California Cancer Registry (2009-2018).

Abstract

22 Background: Androgen deprivation therapy (ADT) is considered standard of care in the treatment of metastatic prostate cancer (mPC). Over the past ten years, the approval of novel androgen receptor-axis-targeted therapies has changed the treatment landscape of mPC. All these novel therapies have only been approved for use in addition to ADT. Despite these new therapeutic advances, it remains unclear how often men with mPC receive standard of care treatment with ADT. Methods: Male adults aged 20 years and older with newly diagnosed metastatic (stage IV) prostate cancer between 2009 and 2018 were identified through the California Cancer Registry (n = 15,435). Patient characteristics including age, year of diagnosis, race/ethnicity, insurance status, socioeconomic status (SES), Charlson co-morbidity score, and death within 3 months of diagnosis were analyzed. Results: 23.1% (n = 3,568) of men with newly diagnosed mPC did not receive ADT. The highest rate of receiving ADT was in men between ages 75-84 (79.6%), and the lowest rate was in men aged over 85 (72.0%) as shown in the table. There was a trend toward more newly diagnosed men receiving ADT in 2018 (81.3%) compared to 2009 (68.8%). Asian men (n = 1077) had a larger proportion of receiving ADT (79.7%), followed by American Indian men (n = 152; 76.4%), Hispanic men (n = 2,368; 75.1%), non-Hispanic White (n = 6,790; 75.6%), and lastly non-Hispanic Black men (n = 1,312; 74.8%). Men from the highest SES had the highest rate of receiving ADT (77.3%), and lowest rate was in lowest SES (73.5%). There was no significant difference among men not receiving hormonal therapy based off Charlson comorbidity score: 0 (26.0%), 1-2 (25.3%), and 3+ (24.9%). Conclusions: Despite significant advancements in the treatment of mPC in recent years, nearly a quarter of patients in California did not receive ADT, which is the backbone for all new systemic therapies. Further statistical analysis of this data set is currently ongoing. This data set might be able to help addressing some of the prostate cancer care disparities in California. [Table: see text]

Letter: Cardiovascular Risk in Prostate Cancer Patients Using Luteinizing Hormone‒Releasing Hormone Agonists or a Gonadotropin-Releasing Hormone Antagonist

“…Since 2013, with the introduction of new treatment modalities (abiraterone, apalutamide, enzalutamide, darolutamide), the panorama in the treatment of metastatic and castration-resistant PCa has changed drastically. 2,3 Decision on the right sequence of drugs is still a matter of great debate; however, ADT is still recommended in combination with chemotherapy or androgen-receptor signaling inhibitor. Nowadays, calculating the cardiovascular risk of patients undergoing ADT is extremely complex and depends on baseline cardiovascular profile, concomitant metabolic factors, lifestyle habits (smoking, alcohol abuse, etc), treatment outcomes, and sequence.…”