Introduction: Prostate cancer (PCa) is the second most common cause of cancer-specific death in US men. Novel oral hormone therapy (NHT) significantly prolongs survival and maintains quality of life in advanced PCa patients. Despite known benefits, these medications are commonly discontinued. The study evaluated the prevalence of early discontinuation of NHT, the determinants of early discontinuation and the effect of changing NHT on duration of treatment.
Methods: A retrospective cohort study of 333 patients with advanced PCa who started a NHT in a single community urology practice in the United States between February 2016 and July 2020 were evaluated. NHT medication, start date of treatment, reason for discontinuation , and discontinuation date were collected. Additional data included demographics, stage of PCa, PSA at time of NHT initiation, Gleason score, and prior PCa treatments. The cohort was divided into 2 subgroups, those did not change medication (Group A) and those that did change to a different NHT (Group B). Student’s t-test, Chi-square test, and Kaplan-Meier survival analysis were carried out to determine significant differences between groups (SPSS).
Results: At one year 28.8% of patient’s had early discontinuation of NHT. The most common reasons for discontinuation were side effects and death at 34.4% each. Group A (282 patients) and Group B (51 patients) discontinued treatment at a rate of 31%, 88%, respectively. Primary reasons for discontinuation in group A versus group B was due to side effects (36% vs 47%) or cancer progression (34% vs 49%). More patients in group B were deceased than in group A (58.8% vs 29.4%). Of those that discontinued, patients remained on NHT for an average of 382 days in group A versus 593 days in group B (Figure 1, Kaplan-Meier analysis p = 0.003). In group B, patients on average discontinued first NHT after 330 days and continued secondary NHT for an additional 263 days.
Conclusions: Side effects and cancer progression were the main reasons for discontinuing NHT treatment. Providing patients with alternative NHT significantly increases the duration of treatment. It is important for clinicians to understand the causes of early discontinuation to develop strategies to maximize duration of therapy for management of advanced PCa.
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