Longitudinal Examination of Metastatic Prostate Cancer Utilizing Linked Health Insurance Claims and Germline Genetic Testing Data

OBJECTIVES: Pathogenic germline variants (PGV) in BRCA1 or BRCA2 are identified in approximately <1% and 5% of patients with metastatic prostate cancer (mPC), respectively. 10-20% of mPC patients will progress to castration-resistant disease (mCRPC). We utilized a linked dataset to characterize mPC and determine if there were significant differences based on BRCA PGV status or race/ethnicity.

METHODS: A linked dataset of germline genetic testing data (InvitaeⓇ) and insurance claims data (Komodo) was assembled for 20,036 patients with ICD9 or ICD10 codes indicating mPC. Race/ethnicity was clinician-reported. Comparative analyses were restricted to White and Black patients. Chi-square, Fisher’s exact and Mann-Whitney U tests were used to determine significance (p<0.05).

RESULTS: The cohort was comprised of White (69.7%), Black (10.4%) and Other (19.9%) patients. Mean age at initial PC diagnosis was 68.0 years; BRCA2+ and Black patients were diagnosed significantly younger (66.5 and 65.5 years, respectively), and White patients significantly older (68.5 years). 11.0% of the cohort had codes indicating mCRPC and 5.9% castration-sensitive disease (mCSPC), with a significantly higher frequency of mCRPC reported for Black vs. White patients (13.0% vs. 11.0%). mPC developed on average 1.3 years, and mCRPC on average 3.1 years after PC diagnosis, with no significant differences in time to progression based on BRCA status or race/ethnicity. 0.6% and 3.5% of patients had BRCA1 and BRCA2 PGVs, respectively, with no significant differences in frequency between Black and White patients or mCRPC vs. mCSPC.

CONCLUSIONS: Our data is concordant with published mPC literature, highlighting the potential of matched genomic and claims data to answer clinically relevant questions. The impact of BRCA status and race/ethnicity on the course of mPC should be further explored.