Urology · 2026
Mortality in Medicare-aged Men With Metastatic Prostate Cancer After the Introduction of Androgen Receptor Pathway Inhibitors: A Population-based Study.
СтатьяНазвание и аннотация: Перевод в очереди
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Kim Isaac E, Hartman Rebecca, Gandhi Krupa, Nikita Nikita, Banks Joshua, Kelly William K, Keith Scott W, Kim Isaac Yi, Lu-Yao Grace
Аннотация
OBJECTIVE: To examine mortality and usage changes after the introduction of androgen receptor pathway inhibitors (ARPI) among older patients with metastatic prostate cancer covered by Medicare.
MATERIALS AND METHODS: The study cohort, consisting of patients newly diagnosed with mPCa, was identified from the surveillance, epidemiology, and end results (SEER)-Medicare Linked Database. The primary outcome was all-cause mortality with time zero at the date of mPCa diagnosis. Patients were classified as pre-ARPI era if diagnosed with mPCa in 2006-2012 and ARPI era if diagnosed in 2013-2019. Mortality was summarized by unadjusted cumulative incidence and evaluated using covariate adjusted mortality hazard ratios (aHRs) from Cox proportional hazards regression modeling.
RESULTS: This study included 9625 patients diagnosed with mPCa (median age 78 years). 44.3% of patients with Medicaid Part D coverage were prescribed therapies in the ARPI era. Stratification by stage revealed that patients with M1a and M1b disease experienced significantly decreased mortality (aHRs: M1a 0.77, 95% CI 0.60-0.98, P = .03; M1b 0.81, 0.77-0.86, P <.01; M1c 0.90, 0.80-1.01; P = .06).
CONCLUSIONS: Since the introduction of ARPIs, the uptake among Medicare patients was relatively high. While we observed a significant 20% lower mortality hazard among patients diagnosed with mPCa after 2013 when ARPIs were introduced, some of the improvement might have resulted from stage migration.
MATERIALS AND METHODS: The study cohort, consisting of patients newly diagnosed with mPCa, was identified from the surveillance, epidemiology, and end results (SEER)-Medicare Linked Database. The primary outcome was all-cause mortality with time zero at the date of mPCa diagnosis. Patients were classified as pre-ARPI era if diagnosed with mPCa in 2006-2012 and ARPI era if diagnosed in 2013-2019. Mortality was summarized by unadjusted cumulative incidence and evaluated using covariate adjusted mortality hazard ratios (aHRs) from Cox proportional hazards regression modeling.
RESULTS: This study included 9625 patients diagnosed with mPCa (median age 78 years). 44.3% of patients with Medicaid Part D coverage were prescribed therapies in the ARPI era. Stratification by stage revealed that patients with M1a and M1b disease experienced significantly decreased mortality (aHRs: M1a 0.77, 95% CI 0.60-0.98, P = .03; M1b 0.81, 0.77-0.86, P <.01; M1c 0.90, 0.80-1.01; P = .06).
CONCLUSIONS: Since the introduction of ARPIs, the uptake among Medicare patients was relatively high. While we observed a significant 20% lower mortality hazard among patients diagnosed with mPCa after 2013 when ARPIs were introduced, some of the improvement might have resulted from stage migration.