Treatment patterns and healthcare resource utilization in patients with metastatic hormone-sensitive prostate cancer and nonmetastatic castration-resistant prostate cancer in China: a real-world observational study

Figures & data

Figure 1. Attrition algorithm for patients with (a) mHSPC and (b) nmCRPC. *Patients identified by definition A and definition B were not mutually exclusive. Abbreviations. mHSPC, metastatic hormone-sensitive prostate cancer; nmCRPC, nonmetastatic castration-resistant prostate cancer; PC, prostate cancer; PSA, prostate-specific antigen.

Figure 2. Prevalence and incidence of patients with (a) mHSPC and (b) nmCRPC over the study period. Abbreviations. mHSPC, metastatic hormone-sensitive prostate cancer; nmCRPC, nonmetastatic castration-resistant prostate cancer.

Table 1. Baseline demographic and clinical characteristics.

Characteristics	mHSPC (N = 1086)	nmCRPC (N = 679)
Age at diagnosis, years, mean (SD)	71.9 (9.3)	74.7 (8.5)
Metastasis location, n (%)
Bone	554 (53.8)	NA
Lung	37 (3.6)	NA
Liver	26 (2.5)	NA
Elsewhere	239 (23.2)	NA
Unknown	230 (21.2)	NA
Total PSA test, ng/mL, mean (SD)/median (IQR)^a	333.30 (1126.3)/37.2 (5.7, 150.8)	68.80 (378.8)/2.8 (0.4, 18.7)
Charlson Comorbidity Index, n (%)
0	2 (0.2)	15 (2.3)
1	0 (0.0)	1 (0.2)
2	230 (21.2)	474 (71.3)
3	49 (4.5)	38 (5.7)
4	38 (3.5)	25 (3.8)
≥5	767 (70.6)	112 (16.8)
Comorbidities, n (%)
Enlargement of prostate	476 (43.8)	83 (12.5)
Urinary tract infection	179 (16.5)	50 (7.5)
Impotence	0 (0.0)	0 (0.0)
Hypertension	430 (39.6)	106 (15.9)
Stroke	111 (10.2)	23 (3.5)
Angina pectoris	20 (1.8)	7 (1.1)
Arrhythmia	67 (6.2)	27 (4.1)
Congestive heart failure	55 (5.1)	9 (1.4)
Hyperlipidemia	63 (5.8)	32 (4.8)
Type 2 diabetes	162 (15.0)	38 (5.8)
Acute coronary syndrome/myocardial infarction	21 (1.9)	5 (0.8)
Liver dysfunction	65 (6.0)	15 (2.3)

IQR, interquartile range; mHSPC, metastatic hormone-sensitive prostate cancer; NA, not applicable; nmCRPC, nonmetastatic castration-resistant prostate cancer; PSA, prostate-specific antigen; SD, standard deviation.

^aN = 509 for mHSPC and N = 657 for nmCRPC.

Figure 3. Medication use at baseline. ADT included LHRH agonist (leuprolide/Leuplin/leuprorelin, goserelin/Zoladex, triptorelin, and histrelin) and LHRH antagonist (degarelix/Gonax). Antiandrogens included bicalutamide and flutamide. Novel hormone therapy included enzalutamide and apalutamide. Abbreviations. ADT, androgen-deprivation therapy; LHRH luteinizing hormone-releasing hormone; mHSPC, metastatic hormone-sensitive prostate cancer; nmCRPC, nonmetastatic castration-resistant prostate cancer; PC prostate cancer.

Figure 4. Sankey diagram detailing changes of first line to second line of treatment in patients with mHSPC. Abbreviations. ADT, androgen-deprivation therapy; mHSPC, metastatic hormone-sensitive prostate cancer.

Table 2. Potentially prostate cancer–related HRU for patients with mHSPC and nmCRPC.

	mHSPC	nmCRPC
	N = 1086	N = 679
Average length of follow-up, months
Mean (SD)	17.57 (17.77)	7.35 (9.96)
Median (IQR)	11.83 (3.75, 24.88)	3.68 (1.02, 9.64)
Inpatient admission
Number (%) of patients with events	894 (82.3%)	137 (20.2%)
Rates (counts of admissions/person-month) with 95% CI	0.52 (0.45, 0.58)	0.69 (0.43, 1)
Cumulative incidence risk (%)	59.69	25.55
Length of stay per inpatient admission in those with ≥1 admission, days
Mean (SD)	8.53 (6.92)	7.16 (7.40)
Median (IQR)	7.00 (4.00, 11.00)	6.00 (2.00, 10.00)
Outpatient visit
Number (%) of patients with events	924 (85.1%)	630 (92.8%)
Rates (counts of visits/person-month) with 95% CI	1.36 (1.17, 1.62)	3.96 (3.29, 4.72)
Cumulative incidence risk (%)	85.9	94.4
Emergency room visit
Number (%) of patients with events	120 (11.0%)	23 (3.4%)
Rates (counts of visits/person-month) with 95% CI	0.1 (0.04, 0.21)	0.05 (0.01, 0.11)
Cumulative incidence risk (%)	11.1	7.29
Surgery
Number (%) of patients with events	575 (53%)	56 (8.2%)
Rates (counts of tests/person-month) with 95% CI	0.23 (0.19, 0.29)	0.21 (0.11, 0.35)
Cumulative incidence risk (%)	26.83	12.93

CI, confidence interval; IQR, interquartile range; mHSPC, metastatic hormone-sensitive prostate cancer; nmCRPC, nonmetastatic castration-resistant prostate cancer; SD, standard deviation.

Table 3. Potentially prostate cancer–related healthcare-associated costs for patients with mHSPC and nmCRPC.

	Cost per person-month, in USD (in all patients)
	mHSPC		nmCRPC
	(N = 1086)		(N = 679)
	Mean (SD)	Median (IQR)	Mean (SD)	Median (IQR)
Inpatient admission	1546.09	402.99	1122.24	0.00
	(3896.48)	(85.49, 1226.24)	(5276.17)	(0.00, 0.00)
Outpatient visit	401.28	146.31	1203.22	372.64
	(939.61)	(1.06, 424.10)	(3235.31)	(139.51, 818.48)
Emergency room visit	16.37	0.00	12.25	0.00
	(340.46)	(0.00, 0.00)	(215.03)	(0.00, 0.00)
Surgery	55.05	0.00	55.56	0.00
	(283.40)	(0.00, 19.31)	(603.36)	(0.00, 0.00)

IQR, interquartile range; mHSPC, metastatic hormone-sensitive prostate cancer; nmCRPC, nonmetastatic castration-resistant prostate cancer; SD, standard deviation.

Data availability statement

The datasets used during this study are not publicly available due to local data access policy but may become available from the corresponding author upon reasonable request.