Treatment patterns and characteristics of European patients with castration-resistant prostate cancer

Abstract

BackgroundEuropean treatment guidelines recommend the use of hormonal therapy for the treatment of advanced prostate cancer, including castration-resistant prostate cancer (CRPC), but there is little understanding of how common practices in prostate cancer treatment compare across Europe. The aim of this analysis was to evaluate the management of CRPC patients across five European countries (France, Germany, Italy, Spain and the UK).MethodsData were drawn from the Adelphi Real World Prostate Cancer Disease Specific Programme (DSP), a cross-sectional survey of patients undertaken between December 2009 and May 2010. The study is based on physician interviews, physician-completed detailed patient record forms, and a patient-completed questionnaire.ResultsA total of 348 physicians (191 urologists and 157 oncologists) reported on 3477 patients with prostate cancer. Of the 3477 patients, 1405 (40%) were categorised as having CRPC, and 1119 of these had metastatic CRPC. Bone metastases were the most common (78%), followed by liver (37%) and lung (30%). The mean age of CRPC patients was 71 years, 35% were current or ex-smokers and 10% had a family history of prostate cancer. CRPC patients had a mean of 1.8 comorbidities; 66% had hypertension and 32% had diabetes. Most physicians estimated their patients would stop responding to initial hormone therapy after 19–24 months. Overall, addition of an anti-androgen to a luteinising-hormone-releasing hormone (LHRH) agonist was the most commonly prescribed therapy when patients failed initial LHRH agonist therapy, although there were considerable variations between countries. While 72% of physicians in Europe would choose chemotherapy as the next treatment option after diagnosis of CRPC, 31% of this group would initially prescribe this without an LHRH agonist.ConclusionsResults from this analysis highlight inconsistencies in common hormonal therapy treatment patterns for CRPC and hormonal therapy across the EU.

Resource utilization and use of life-extending therapies and corticosteroids in prostate cancer patients with corticosteroid-sensitive comorbidities

“…Baseline characteristics of patients in this study were also similar to those of patients with CRPC across five European countries (France, Germany, Italy, Spain, and the United Kingdom) 31 . Most patients in the European study were elderly, with a mean age of 71 years and mean of 1.8 comorbidities, most frequently hypertension (65.6%) and diabetes (31.7%); with bone the most common site of metastases.…”

Optimizing the role of androgen deprivation therapy in advanced prostate cancer: Challenges beyond the guidelines

“…The American Society of Clinical Oncology and NCCN recommend that ADT should be continued indefinitely in the setting of mPC despite the development of castration resistance 9,73 . But a survey of PC physicians from five European countries (France, Germany, Italy, Spain, and the United Kingdom) found that up to one third of physicians used chemotherapy as a monotherapy and stopped administering ADT after the development of castration resistance 74 . The panel did not endorse discontinuing ADT after emergence of castration‐resistant disease.…”

Androgen deprivation therapy as backbone therapy in the management of prostate cancer

“…5 Cross-sectional survey data from 3,477 patients with CRPC in five countries (France, Germany, Italy, Spain and the UK) revealed that between 19% and 45% (in the UK and Italy, respectively) of patients received chemotherapy alone with no ADT (Figure 1). The reasons for this divergence between guidelines and clinical practice are unclear, and this study reported no consistent link between years of practice and likelihood of continuing ADT in CRPC 5. However, this apparent tendency for some clinicians to overlook the need for continued ADT may expose patients to unnecessary risk.…”

“…A 6-month retrospective study of 73 men with non-mPCa found that any recorded testosterone peak above 1.1 nmol/L (32 ng/dL) was associated with significantly impaired survival free of androgen independent progression (88 months [95% CI, 55–121] versus 137 months [95% CI, 104–170], respectively; P <0.03) 11. In addition, rising PSA levels are commonly used to diagnose CRPC in the clinic, with a minority of oncologists or urologists citing testosterone levels as an additional marker, according to a European survey 5. Clinical trials have continued to use the <1.7 nmol/L testosterone cutoff, although some studies are starting to explore lower cutoff values 12.…”

“…ADT can delay metastatic PCa (mPCa) progression for around 2 years on average, but most patients will eventually develop castration-resistant PCa (CRPC) 5. PCa growth remains dependent on androgen receptor (AR) signaling, even after the development of CRPC, highlighting the need to maintain ADT 6…”