Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
Department of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
Scand J Urol. 2021 Aug;55(4):299-306. doi: 10.1080/21681805.2021.1936626. Epub 2021 Jun 7.
Studies describing treatment utilization for castration-resistant prostate cancer (CRPC) are limited. We aimed to describe the treatment utilization of a contemporary population-based CRPC cohort between 2006 and 2016.
We identified 1699 men with a PC diagnosis between 2005 and 2015, who developed CRPC between 2006 and 2015 in the Stockholm region of Sweden. Demographic information, stage and grade at PC diagnosis, stage at CRPC, prostate-specific antigen (PSA) nadir, PSA doubling time, treatment utilization rate within 1 year of CRPC diagnosis, reason for stopping therapy, treatment sequence trajectory, overall and PC specific survival was described.
Treatment for men with de novo metastatic disease ( = 463) was 32%, treatment for men with progressive metastatic disease after PC diagnosis ( = 66) was 44%, treatment for men with nonmetastatic CRPC ( = 113) was 34% and treatment for those with an unknown stage at time of CRPC diagnosis ( = 857) was 12%. Docetaxel was used in 39%, abiraterone acetate plus prednisone in 15%, enzalutamide in 13%, cabazitaxel in 11% and radium-223 in 5% of treatments. Treatment increased from 22% in 2006-2009 for metastatic cancer to 50% in 2013-2015 ( < .001). Factors associated with treatment were an unknown stage at diagnosis (OR: 0.3, 95% CI: 0.2-0.4), age ≥75 years (OR: 0.2, 95% CI: 0.1 - 0.3), PSA doubling time >3 months (OR: 0.4, 95% CI: 0.3 - 0.6) and a diagnosis between 2013 and 2015 (OR: 3.4, 95% CI: 2.0 - 5.8).
Despite treatment availability, in this large real-world cohort we found treatment utilization to remain low.
描述去势抵抗性前列腺癌（CRPC）治疗利用情况的研究有限。我们旨在描述 2006 年至 2016 年间当代基于人群的 CRPC 队列的治疗利用情况。
我们在瑞典斯德哥尔摩地区确定了 1699 名 2005 年至 2015 年间诊断出前列腺癌（PC）的男性，他们在 2006 年至 2015 年间发展为 CRPC。描述了人口统计学信息、PC 诊断时的分期和分级、CRPC 时的分期、前列腺特异性抗原（PSA）最低值、PSA 倍增时间、CRPC 诊断后 1 年内的治疗利用率、停止治疗的原因、治疗顺序轨迹、总生存和 PC 特异性生存。
新发转移性疾病患者（n=463）的治疗率为 32%，PC 诊断后进展性转移性疾病患者（n=66）的治疗率为 44%，非转移性 CRPC 患者（n=113）的治疗率为 34%，CRPC 诊断时分期未知的患者（n=857）的治疗率为 12%。39%的患者接受了多西他赛治疗，15%的患者接受了阿比特龙联合泼尼松治疗，13%的患者接受了恩杂鲁胺治疗，11%的患者接受了卡巴他赛治疗，5%的患者接受了镭-223 治疗。治疗从 2006-2009 年转移性癌症的 22%增加到 2013-2015 年的 50%（<.001）。与治疗相关的因素包括诊断时分期未知（OR：0.3，95%CI：0.2-0.4）、年龄≥75 岁（OR：0.2，95%CI：0.1-0.3）、PSA 倍增时间>3 个月（OR：0.4，95%CI：0.3-0.6）和 2013-2015 年诊断（OR：3.4，95%CI：2.0-5.8）。
尽管有治疗方法，但在这个大型真实世界队列中，我们发现治疗的利用率仍然很低。
