Faraj Kassem S, Oerline Mary, Kaufman Samuel, Maganty Avinash, Caram Megan E V, Shahinian Vahakn B, Hollenbeck Brent K
Dow Division of Health Services Research, University of Michigan, Ann Arbor, Michigan, USA.
VA Health Services Research, Centers for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA.
Cancer Med. 2025 Sep;14(17):e71219. doi: 10.1002/cam4.71219.
In the past decade, the management of advanced prostate cancer has shifted to novel hormonal therapies. As a result, urologists have increased their involvement in the management of advanced prostate cancer. These therapies require close monitoring due to the possibility of adverse cardiometabolic events. We assessed outcomes among men diagnosed with advanced prostate cancer started on novel hormonal therapy by a urologist compared to those by a medical oncologist.
We performed a retrospective cohort study of Medicare beneficiaries with advanced prostate cancer treated with a novel hormonal therapy between 2012 and 2019. The primary outcome was an adverse event comprised of a hospital visit for a cardiometabolic event within 6 months of starting a novel hormonal therapy. Secondary outcomes included monthly out-of-pocket costs and treatment adherence.
There were 1212 (23%) and 4124 (77%) patients who were prescribed a novel hormonal therapy for the first time by a urologist and medical oncologist, respectively. No difference in the composite adverse event measure was observed in those managed by urologists or medical oncologists (4.2% vs. 4.7%, respectively, p = 0.49). Out-of-pocket costs, in men without low-income subsidies, did not vary by specialty ($772 vs. $790, p = 0.58). Adherence to treatment did not vary in men managed by urologists or medical oncologists (75% vs. 74%, respectively, p = 0.64).
The specialty of the physician prescribing a novel hormonal therapy was not associated with the risk of a cardiometabolic adverse event. Further, management by a urologist did not adversely affect costs to patients or adherence.
在过去十年中，晚期前列腺癌的治疗已转向新型激素疗法。因此，泌尿科医生在晚期前列腺癌治疗中的参与度有所提高。由于存在发生不良心脏代谢事件的可能性，这些疗法需要密切监测。我们评估了由泌尿科医生开始接受新型激素疗法的晚期前列腺癌男性患者与由医学肿瘤学家治疗的患者的治疗结果。
我们对2012年至2019年间接受新型激素疗法治疗的晚期前列腺癌医疗保险受益人进行了一项回顾性队列研究。主要结局是在开始新型激素疗法后6个月内因心脏代谢事件住院就诊所构成的不良事件。次要结局包括每月自付费用和治疗依从性。
分别有1212名（23%）和4124名（77%）患者首次由泌尿科医生和医学肿瘤学家开具新型激素疗法处方。在由泌尿科医生或医学肿瘤学家管理的患者中，复合不良事件指标未观察到差异（分别为4.2%和4.7%，p = 0.49）。在没有低收入补贴的男性中，自付费用不因专科而异（772美元对790美元，p = 0.58）。由泌尿科医生或医学肿瘤学家管理的男性患者的治疗依从性没有差异（分别为75%和74%，p = 0.64）。
开具新型激素疗法处方的医生专科与心脏代谢不良事件风险无关。此外，由泌尿科医生进行管理对患者费用或依从性没有不利影响。
