OBJECTIVES

To gain real-world insight to the different providers and treatment patterns throughout the natural history of disease.

METHODS

A retrospective analysis of the Optum^TM claims database was conducted in evaluating adult males ( ≥ 18 years) with a prostate cancer diagnosis, received at least one androgen deprivation therapy (ADT) and had an mCRPC treatment between January 1, 2013 and November 30, 2016. Patients were defined as metastatic, hormone sensitive prostate cancer (mHSPC) or non-metastatic, castration-resistant prostate cancer (nmCRPC) based on whether the first claim for metastasis was prior to or after the first line castration. Proportion of patients from diagnosis to first treatment by provider type was plotted on Sankey graphs. Factors associated with treatment choice between abiraterone and enzalutamide were analyzed by logistic regression.

RESULTS

A greater proportion of patients progressed to mCRPC from mHSPC (65%) than from nmCRPC (35%). While both cohorts were treated by multidisciplinary physicians through their disease journey, a greater proportion of the nmCRPC cohort was treated by a urologist at initial diagnosis, while at the mCRPC stage, both cohorts were mainly treated by a medical oncologist. Patients who were seen by a medical oncologist at initial diagnosis were more likely to be treated by a medical oncologist at mCRPC stage. Abiraterone or enzalutamide were the most common administrated treatments, 51.1% vs. 26.3%, respectively. Medical oncologists were 2.39 times (95% CI 1.74-3.28) more likely than urologists to prescribe abiraterone, and commercially insured patients were 1.43 times (95% CI 1.10-1.87) more likely than Medicare patients to be treated with abiraterone. There was no significant difference in treatment choices between progression pathways.

CONCLUSIONS

Though provider pathways were different between mHSPC and nmCRPC cohorts, both were managed multi-disciplinarily over their diagnosis and progression journey. Provider type and insurance appear to influence choice of mCRPC treatment, independent of the disease progression pathways.