OBJECTIVES : To understand treatment management of non-metastatic castration-resistant prostate cancer (nmCRPC) in patients with pre-existing comorbidities.

METHODS : Physicians who treated nmCRPC patients with systemic therapy were recruited from a US physician panel for an online survey (Sept-Oct 2019). All data were physician-reported and comprised measures describing physician treatment practice and demographic characteristics, as well a 'typical' nmCRPC patient from past 6 months (e.g., health profile, disease management, and quality of life [based on the Prostate Cancer Specific Quality of Life Instrument, PROSQOLI). Chi-square, Fisher's exact, or median tests examined differences between physician specialty

RESULTS : Fifty physicians (56% urologists, 44% oncologists) participated in the survey. Urologists reported treating more nmCRPC patients in the past 6-months than did oncologists (median=18 vs 9 patients, respectively; p<0.001). The most common treatments reported were leuprolide acetate (82%), enzalutamide (80%), and apalutamide (70%) with no difference by physician specialty (p>0.05). Most physicians (~90%) reported at least one patient with hypertension, diabetes, myocardial infarction, sexual dysfunction or urinary issues, and up to 28% of physicians reported at least two-thirds of their patients having any one of these conditions. Between 23-46% of physicians reported that up to one-third of these patients' comorbidities were not well-controlled prior to nmCRPC treatment. About one-third of physicians reported ever adjusting the dose or switching nmCRPC treatment due to one of these comorbidities. For example, 31% of physicians reported adjusting cancer treatment dosing and 34% reported switching cancer treatment for patients with hypertension. Physician-reported PROSQOLI for a 'typical' nmCRPC patient prior to and following treatment noted increased fatigue (median difference=5.5, p=0.019) and limited enjoyment time (median difference=4.0, p=0.056) following treatment.

CONCLUSIONS : The prevalent comorbidity burden in nmCRPC patients can impact treatment decisions. Understanding patient health and quality of life burden are relevant for identifying critical target areas in the evolving landscape of nmCPRC treatment.