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Updated: Sep 2, 2025
A Bioluminescent and Fluorescent Orthotopic Syngeneic Murine Model of Androgen-dependent and Castration-resistant Prostate Cancer
Published on: March 6, 2018
Patterns of care for non-metastatic castration-resistant prostate cancer: A population-based study
Shawn Malone1, Christopher J D Wallis2, Richard Lee-Ying3
1The Ottawa Hospital University of Ottawa Ottawa Ontario Canada.
Objectives:
To describe patterns of practice of PSA testing and imaging for Ontario men receiving continuous ADT for the treatment of non-metastatic castration-resistant prostate cancer (nmCRPC).
Patients And Methods:
This was a retrospective, longitudinal, population-based study of administrative health data from 2008 to 2019. Men 65 years and older receiving continuous androgen deprivation therapy (ADT) with documented CRPC were included. An administrative proxy definition was applied to capture patients with nmCRPC and excluded those with metastatic disease. Patients were indexed upon progression to CRPC and were followed until death or end of study period to assess frequency of monitoring with PSA tests and conventional imaging. A 2-year look-back window was used to assess patterns of care leading up to CRPC as well as baseline covariates.
Results:
At a median follow-up of 40.1 months, 944 patients with nmCRPC were identified. Their median time from initiation of continuous ADT to CRPC was 26.0 months. 60.7% of patients had their PSA measured twice or fewer in the year prior to index, and 70.7% patients did not receive any imaging in the year following progression to CRPC. Throughout the study period, 921/944 (97.6%) patients with CRPC progressed to high-risk (HR-CRPC) with PSA doubling time ≤ 10 months, of which more than half received fewer than three PSA tests in the year prior to developing HR-CRPC, and 30.9% received no imaging in the subsequent year.
Conclusion:
PSA testing and imaging studies are underutilized in a real-world setting for the management of nmCRPC, including those at high risk of developing metastatic disease. Infrequent monitoring impedes proper risk stratification, disease staging and detection of treatment failure and/or metastases, thereby delaying the necessary treatment intensification with life-prolonging therapies. Adherence to guideline recommendations and the importance of timely staging should be reinforced to optimize patient outcomes.
Insights
PSA testing and imaging are underutilized for non-metastatic castration-resistant prostate cancer (nmCRPC) management. This infrequent monitoring hinders risk stratification and timely treatment intensification, impacting patient outcomes.
Area of Science:
- Oncology
- Urology
- Health Services Research
Background:
- Non-metastatic castration-resistant prostate cancer (nmCRPC) requires careful monitoring for disease progression.
- Androgen deprivation therapy (ADT) is a standard treatment for advanced prostate cancer.
- Optimal surveillance strategies for nmCRPC are crucial for timely intervention.
Purpose of the Study:
- To describe patterns of PSA testing and imaging for Ontario men with nmCRPC receiving continuous ADT.
- To evaluate the frequency of monitoring practices in this patient population.
- To identify potential gaps in care regarding diagnostic testing.
Main Methods:
- Retrospective, population-based study using administrative health data (2008-2019).
- Inclusion of men aged 65+ receiving continuous ADT with CRPC, using a proxy definition for nmCRPC.
- Assessment of PSA test and conventional imaging frequency following CRPC diagnosis and progression.
Main Results:
- 944 nmCRPC patients identified; median follow-up 40.1 months.
- 60.7% had ≤2 PSA tests and 70.7% had no imaging in the year post-progression.
- High-risk nmCRPC progression (97.6%) often occurred with infrequent monitoring.
Conclusions:
- PSA testing and imaging are underutilized in real-world nmCRPC management.
- Infrequent monitoring impedes risk stratification and timely treatment intensification.
- Reinforcing guideline adherence for timely staging is essential for optimizing outcomes.
