Real World Hospitalizations in US Veterans Treated for Metastatic Prostate Cancer with Combination Therapy

Treatment of metastatic hormone sensitive prostate cancer (mHSPC) has traditionally included combination therapy of androgen deprivation therapy (ADT) with docetaxel or an androgen receptor pathway inhibitor (ARPI). There are no comparative studies to compare the real-world hospitalization rates and adverse events (AEs).

A nationwide retrospective study of 1549 US veterans was conducted to compare treatment with ADT+docetaxel (n = 500) versus ADT+ARPI (n = 1049) between 2013 and 2021. Hospitalizations were determined 1 year before and after treatment. Baseline cohort characteristics and incidence rate differences of adverse events were then compared in the year prior to treatment with the year after.

In patients who received ADT+docetaxel, hospitalizations increased by 245%, and ADT+ARPI hospitalizations increased by 125% (P < .001). The docetaxel cohort was younger and had fewer comorbidities (median age 66.8 vs. 73.4 years; CCI 1 vs. 2). Docetaxel had higher rates of hospitalizations due to digestive (+ 600%, P < .001) and respiratory complications (+ 157%, P = .04). The ARPI cohort had increased hospitalizations due to respiratory (+ 243%, P < .001), endocrine/metabolic (+ 80%, P = .002), and circulatory complications (+ 64%, P = .009). The ARPI cohort had a decrease in acute renal failure admissions (-24%, P = .401).

Overall, in the real-world setting, the 2 therapy regimens have distinct hospitalization risks and AEs. Patients with respiratory and gastrointestinal comorbidities may be at higher risk when receiving treatment with docetaxel. Alternatively, older and frailer patients who are susceptible to infections and metabolic complications may be at increased risk with ARPIs. These findings may aid physicians in determining the optimal, individualized therapy to mitigate adverse outcomes in patients with mHSPC.