Rannikko Antti, Hölsä Olivia, Ågesen Trude, Ekman Mattias, Mattila Riikka
Department of Urology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland; Research Programme in Systems Oncology, Faculty of Medicine, University of Helsinki, Helsinki, Finland.
Medaffcon Oy, Espoo, Finland.
Acta Oncol. 2025 Jan 29;64:173-178. doi: 10.2340/1651-226X.2025.42173.
Metastatic castration-resistant prostate cancer (mCRPC) treatment is advancing yet Nordic, real-world evidence for its use is scarce. In this population-based cohort study, we describe characteristics of patients with mCRPC, and their treatment patterns and survival outcomes in Finland.
Incident patients with mCRPC diagnosed during 2013-2021 were identified from data lakes in two large and representative, Finnish hospital districts, and linked to data on drug purchases and causes of death from national registries.
Of a total of 31,307 patients with prostate cancer, 2,475 progressed to mCRPC during 2013-2021. Those who received no life-prolonging treatment(s) (28% overall) were older with more comorbidities than treated patients. After 2018, the proportion of patients who received life-prolonging treatments increased from 61% to 80%. Of those who received treatment before androgen receptor pathway inhibitors (ARPIs) were reimbursed as first-line (1L) treatment for mCRPC in Finland, 68% received docetaxel, 19% abiraterone and 12% enzalutamide 1L; post-reimbursement, 4% received docetaxel, 24% abiraterone and 71% enzalutamide 1L. Median overall survival for treated patients with mCRPC was 28.3 (95% CI: 26.3-30.4) and 38.5 (95% CI: 32.7-42.1) months pre- and post-reimbursement of 1L-ARPIs, respectively.
The ARPI reimbursement status changes significantly influenced treatment patterns for mCRPC in Finland, favouring enzalutamide over docetaxel. This expanded the pool of men eligible for 1L treatment and improved overall survival by a median of 10 months. These findings highlight the importance of health policy decisions in shaping treatment strategies and patient outcomes in prostate cancer.
转移性去势抵抗性前列腺癌（mCRPC）的治疗正在不断发展，但在北欧，关于其使用的真实世界证据却很少。在这项基于人群的队列研究中，我们描述了芬兰mCRPC患者的特征、治疗模式和生存结果。
从芬兰两个大型且具有代表性的医院区的数据湖中识别出2013年至2021年期间确诊的mCRPC初发患者，并将其与国家登记处的药品购买数据和死亡原因数据相链接。
在总共31307例前列腺癌患者中，有2475例在2013年至2021年期间进展为mCRPC。那些未接受延长生命治疗的患者（总体占28%）比接受治疗的患者年龄更大，合并症更多。2018年后，接受延长生命治疗的患者比例从61%增加到80%。在芬兰，雄激素受体通路抑制剂（ARPI）作为mCRPC的一线（1L）治疗报销之前接受治疗的患者中，68%接受多西他赛，19%接受阿比特龙，12%接受恩杂鲁胺1L治疗；报销后，4%接受多西他赛，24%接受阿比特龙，71%接受恩杂鲁胺1L治疗。接受治疗的mCRPC患者的中位总生存期在1L-ARPI报销前和报销后分别为28.3（95%CI：26.3-30.4）个月和38.5（95%CI：32.7-42.1）个月。
ARPI报销状态的变化显著影响了芬兰mCRPC的治疗模式，使恩杂鲁胺比多西他赛更受青睐。这扩大了符合1L治疗条件的男性群体，并使中位总生存期提高了10个月。这些发现凸显了卫生政策决策在塑造前列腺癌治疗策略和患者结局方面的重要性。
