DURHAM, NC — What is the association between prostate-specific antigen doubling time (PSADT) with metastasis-free survival (MFS) and overall survival (OS) in VHA patients with nonmetastatic castrate-resistant prostate cancer (nmCRPC)?

That is the question raised in a study published in the Journal of Urologic Oncology which also sought to describe healthcare resource utilization (HRU) and costs among those patients.

Researchers from the Durham, NC, VAMC and Cedars-Sinai Medical Center in Los Angeles identified patients with nmCRPC from the VHA electronic health record database from January 2007 to August 2017. PSADT was categorized as less than three months, three to nine months, nine to 15 months, 15 months or greater, and unknown.

Researchers determined that, among 12,083 patients in the study, shorter PSADT was associated with shorter MFS and OS (PSADT < 3 months vs. PSADT ≥15 months hazard ratio [HR] [95% confidence interval (CI)] = 0.307 [0.281, 0.335] and 0.371 [0.335, 0.410], respectively).

At the same time, patients who developed metastasis had a threefold higher risk of death compared to those without metastasis (HR [95% CI] = 2.933 [2.763, 3.113]). In addition, mean HRU increased following the onset of nmCRPC and metastatic castrate-resistant prostate cancer (mCRPC), and mean inpatient stays more than doubled (0.2 vs. 0.5 and 0.6 vs. 2.8 PPPY, respectively).

The authors pointed out that similar increases in healthcare costs were observed. Among those were pharmacy costs, which more than tripled following nmCRPC ($2,074 vs. $6,839 PPPY). From nmCRPC to mCRPC, meanwhile, researchers said large increases were observed for inpatient costs ($7,257-$61,691), emergency room costs ($844-$1,958) and pharmacy costs ($4,115-$26,279) PPPY.

“In veterans with nmCRPC, shorter PSADT was significantly associated with shorter MFS and OS,” the authors concluded. “Onset of nmCRPC and mCRPC was associated with substantial HRU and cost increases.”

  1. Freedland SJ, Pilon D, Bhak RH, Lefebvre P, Li S, Young-Xu Y. Predictors of survival, healthcare resource utilization, and healthcare costs in veterans with non-metastatic castration-resistant prostate cancer. Urol Oncol. 2020 Jul 29:S1078-1439(20)30324-0. doi: 10.1016/j.urolonc.2020.07.002. Epub ahead of print. PMID: 32739230.