Treatment and monitoring of men with metastatic castration-resistant prostate cancer

Abstract

Several new treatments for men with metastatic castration-resistant prostate cancer (mCRPC) have shown survival benefits in randomized controlled trials (RCTs) over the past 15 years. Real-world evidence is needed to assess their effectiveness outside clinical trials. As men with mCRPC live longer, health care needs to adapt. Patient management may be improved by using a graphical overview that displays individual patient data including patient-reported outcome measures (PROMs). This thesis aims to evaluate the effectiveness of three treatments for mCRPC introduced in the 2010s, and to evaluate a patient overview for monitoring men on treatments for mCRPC. We used nationwide, population-based register data to compare outcomes in Swedish clinical practice with those reported from RCTs (papers I and II). We show that time on treatment for men on abiraterone or enzalutamide and overall survival for radium-223-treated men were similar to those reported from the RCTs, even though men in clinical practice were older, had worse performance status, and had more comorbidities. In paper II we investigated the association between line of treatment of radium-223 and overall survival in men with mCRPC. Our results do not support previous conclusions of a survival benefit with earlier use. Paper III, a randomized study on Patient-overview Prostate Cancer (PPC), shows that PPC provides health care staff with more rapid access to clinical information in comparison to electronic health records. Paper IV presents a study protocol for a multicenter RCT evaluating whether the use of PROMs affects symptom communication. In conclusion, this thesis shows that men with mCRPC are appropriately treated with abiraterone, enzalutamide, or radium-223 in Swedish clinical practice. When monitoring men with mCRPC, a graphical overview may facilitate information retrieval. An RCT to evaluate whether the use of PROMs before and during a clinical encounter improves symptom communication and shared decision-making for men with advanced prostate cancer is planned to begin in late 2026.