OBJECTIVES: Diagnostic workup and primary treatment of prostate cancer (PC) in Sweden is registered in the National PC Register (NPCR). However, there are no data on progression from nonmetastatic (nm) or metastatic (m) hormone-sensitive PC (HSPC) to castration-resistant PC (CRPC) in men on androgen deprivation therapy in NPCR. The aim of this study was to assess time from disease state entry to progression or death from nm/mHSPC through nm/mCRPC, as well as co-medications, comorbidities, and health care resource use.

METHODS: Real-world data were extracted from the Prostate Cancer Database Sweden (PCBase), a registry linking data from Patient-overview PC (PPC), national health care registries, and demographic databases covering 2006–2016. Overall survival (OS) and time to progression (TTP) were estimated using Kaplan-Meier and cumulative incidence functions.

RESULTS: 1869 men were included. Mean age ranged from 70.1 years for mHSPC to 74.8 years for nmCRPC. Median OS and median TTP for men with nmHSPC (n=1034) were 11 and 4 years, respectively. The corresponding numbers for mHSPC (n=884) were 7 and 1.3 years; and for nmCRPC (n=356), 8.5 and 1.4 years. Median OS for mCRPC (n=1172) was 3.9 years. The most common co-medications included analgesics and antipyretics. The most common comorbidities were cardiovascular (myocardial infarction and congestive heart disease) and diabetes, both of which affected 5–9%. Costs for hospitalizations, outpatient visits, and PC treatments increased with increasing disease severity. Mean annual health care-related costs ranged from SEK 37,000 for nmHSPC to SEK 281,000 for mCRPC.

CONCLUSIONS: Time spent in mHSPC and nmCRPC was relatively short; and men soon progressed to mCRPC where they spent substantially longer time. Time spent in mHSPC and nm/mCRPC is of particular interest since recent data from clinical trials support treatment to prolong life but at a high cost.

FUNDING: Astellas Pharma, Kastrup, Denmark. Editorial support: Complete HealthVizion.