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Treatment Trends for Metastatic Prostate Cancer over the Last Decade: Insights from the National Cancer Database
Jared P. Schober, MD, Kristian D. Stensland, MD, Alireza Moinzadeh, MD, David Canes, MD.
Lahey Hospital and Medical Center, Burlington, MA, USA.

Background:
The incidence of metastatic prostate cancer has been increasing over the past decade. The landscape of treatment options has changed over this time period with the addition of new approaches to treatment, including the immunologic Sipuleucel-T (approved in 2010), and the chemotherapeutic agent Docetaxel, for which level 1 evidence for its first line use in hormone-sensitive disease became available in 2015. To our knowledge, there is no previous large scale study investigating the trends in management over the last 10 years, nor baseline utilization of newer agents.
Methods:
The National Cancer Database (NCDB) was used to identify cases of metastatic prostate cancer, defined as cM1, between 2004-2014. No changes to diagnostic criteria of metastatic disease were made during this time period. To minimize reporting bias, only hospitals contributing at least one case per year for the entire decade were included. Treatments codes were categorized and compared between years of diagnosis. Descriptive statistics were performed in Stata.
Results:
A total of 49,586 cases were included. The percentage of patients opting for surgical intervention as a care component (mostly palliative TURP) decreased over time, 12.7% in 2004 vs. 11% in 2014. Likewise, there has been a slight decrease in utilization of all forms of radiation therapy with 26.9% receiving radiotherapy in 2004 compared to 24.6% in 2014. The use of hormone therapy has increased 10% over the last decade (70.5% vs. 80.8%). Use of chemotherapy rose sharply over recent years but remains low. Single agent chemotherapy has increased from 3% in 2013 to 14% in 2014. Sipuleucel-T immunotherapy has seen modest use since its FDA approval in 2010, comprising <1% of patients in 2010, to 6.4% in 2014.
Conclusion:
The treatment landscape for prostate cancer has changed dramatically over the last 10 years. Primary treatment plans are less likely to include radiation or surgical intervention, as one would expect given that local control is uncommonly recommended in the context of metastatic disease. The usage of hormone therapy continues to rise. Use of immunotherapy with Sipuleucel-T remained low at CoC accredited hospitals four years after its introduction. Possibly as a reflection of CHAARTED demonstrating benefit in high volume M1 disease, docetaxel use increased in 2014. Based on recent evidence supporting its first-line use for castrate sensitive M1 disease we suspect increased utilization going forward, with our study serving as a baseline for future comparison.


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