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Updated: Dec 13, 2025
A Bioluminescent and Fluorescent Orthotopic Syngeneic Murine Model of Androgen-dependent and Castration-resistant Prostate Cancer
Published on: March 6, 2018
Patient and caregiver benefit-risk preferences for nonmetastatic castration-resistant prostate cancer treatment
Sandy Srinivas1, Ateesha F Mohamed2, Sreevalsa Appukkuttan2
1Stanford University Medical Center, Palo Alto, CA, USA.
Background:
Recently approved second-generation androgen receptor inhibitors (SGARIs) for non-metastatic castration-resistant prostate cancer (nmCRPC) have similar efficacy but differ in safety profiles. We used a discrete choice experiment (DCE) to examine how nmCRPC patients and caregivers perceive the benefits versus risks of these new treatments.
Methods:
An online DCE survey with 14 treatment choice questions was administered to nmCRPC patients and caregivers. Each choice question compared two hypothetical medication profiles varying in terms of 5 safety attributes (risk or severity of adverse events [AEs]: fatigue, skin rash, cognitive problems, serious fall, and serious fracture) and two efficacy attributes (duration of overall survival [OS] and time to pain progression). Random parameters logit models were used to estimate each attribute's relative importance. We also estimated the amounts of OS that respondents were willing to forego for a reduction in AEs.
Results:
In total, 143 nmCRPC patients and 149 caregivers viewed the AEs in following order of importance (most to least): serious fracture, serious fall, cognitive problems, fatigue, and skin rash. On average, patients were willing to trade 5.8 and 4.0 months of OS to reduce the risk of serious fracture and fall, respectively, from 3% to 0%; caregivers were willing to trade 6.6 and 5.4 months of OS.
Conclusions:
nmCRPC patients and caregivers preferred treatments with lower AE burdens and were willing to forego OS to reduce the risk and severity of AEs. Our results highlight the importance of carefully balancing risks and benefits when selecting treatments in this relatively asymptomatic population.
Insights
Patients and caregivers prioritize reducing adverse events (AEs) over overall survival (OS) when choosing treatments for non-metastatic castration-resistant prostate cancer (nmCRPC). They are willing to trade OS to minimize risks like serious fractures and falls.
Area of Science:
- Oncology
- Patient-Reported Outcomes
- Pharmacoeconomics
Background:
- Second-generation androgen receptor inhibitors (SGARIs) offer similar efficacy for non-metastatic castration-resistant prostate cancer (nmCRPC) but have distinct safety profiles.
- Understanding patient and caregiver preferences for treatment benefits versus risks is crucial for shared decision-making in nmCRPC management.
Purpose of the Study:
- To assess how nmCRPC patients and their caregivers perceive and prioritize the risks and benefits of SGARIs.
- To quantify the trade-offs patients and caregivers are willing to make between overall survival (OS) and adverse events (AEs).
Main Methods:
- A discrete choice experiment (DCE) survey was administered to 143 nmCRPC patients and 149 caregivers.
- Respondents evaluated hypothetical treatment profiles varying in safety attributes (fatigue, skin rash, cognitive problems, serious fall, serious fracture) and efficacy attributes (OS duration, time to pain progression).
- Random parameters logit models estimated attribute importance and willingness-to-trade OS for AE risk reduction.
Main Results:
- Serious fracture and serious fall were the most important AEs for both patients and caregivers.
- Patients were willing to trade a median of 5.8 months of OS to eliminate the risk of serious fracture and 4.0 months for serious falls.
- Caregivers showed a higher willingness-to-trade, valuing OS reduction at 6.6 months for fractures and 5.4 months for falls.
Conclusions:
- nmCRPC patients and caregivers strongly prefer treatments with lower AE burdens.
- There is a significant willingness to forego overall survival to reduce the risk and severity of specific adverse events.
- Balancing treatment risks and benefits is essential for selecting optimal therapies in the nmCRPC population, particularly given their often asymptomatic state.
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