Abstract
BACKGROUND: Prostate cancer (PC) patients resistant to castration have decreased survival. Analysis of patient characteristics and disease management can contribute to new strategies to prevent or delay progression to castrate-resistant prostate cancer (CRPC). This study aimed to characterize and compare PC patients from initial PC diagnosis to metastatic CRPC (mCRPC) versus nonmetastatic (nmCRPC) stages in a real-world setting in Portugal. METHODS: A multicenter, retrospective, non-interventional study was conducted across 18 Portuguese sites. Consenting adult patients (age ≥ 18 years) diagnosed with CRPC, either metastatic or nonmetastatic, were included in the study at the time of diagnosis or within 12 months of CRPC diagnosis. RESULTS: Between November 2020 and December 2022, a total of 121 patients (73 mCRPC patients and 48 nmCRPC patients) were included. At diagnosis, the median age was 69.0 and 70.0 years in mCRPC and nmCRPC patients, respectively, and the most common histological subtype was acinar adenocarcinoma (mCRPC: 83.6%; nmCRPC: 91.7%). Significant differences were observed between the two groups regarding Eastern Cooperative Oncology Group Performance status (ECOG PS) (p = 0.023), Gleason score (p = 0.001), and American Joint Committee on Cancer (AJCC) stage (p < 0.001). The median time from PC diagnosis to first treatment and the treatments used prior to CRPC diagnosis were comparable between the groups. However, the median time from PC diagnosis to CRPC was significantly shorter in mCRPC versus nmCRPC patients (42.0 vs. 58.0 months, p = 0.006). Prostate-specific antigen (PSA) values were significantly higher in mCRPC than in nmCRPC patients at CRPC diagnosis (19.8 vs. 6.3 ng/mL; p < 0.001). CONCLUSIONS: This real-world study showed that the time from initial PC diagnosis to castration resistance was significantly longer in nmCRPC than in mCRPC patients. The characteristics associated with a better prognosis at initial diagnosis and a better treatment response in nmCRPC patients might explain this difference in disease progression.