Epidemiology and treatments of neuroendocrine prostate cancer in a large commercially insured population in the US.

BACKGROUND

Neuroendocrine prostate cancer (NEPC) is a highly aggressive prostate cancer (PCa) subtype diagnosed de novo or arising from neuroendocrine differentiation of adenocarcinoma following androgen deprivation therapy (ADT) or antiandrogen-based therapy. The objective of the study was to describe socio-demographic and clinical characteristics at the time of NEPC diagnosis and treatment patterns prior to and after NEPC diagnosis.

PATIENTS AND

METHODS

A real-world cohort of men diagnosed with NEPC was identified using the US Optum Clinformatics® administrative claims database between 2007 and 2023. The study was descriptive in nature, without comparative analyses.

RESULTS

Of the 607,280 patients diagnosed with PCa, 2267 (0.4%) had a diagnosis of NEPC. Median age at NEPC diagnosis was 76 years; 72% of patients were White, and half of patients had a Charlson Comorbidity Index score of 0-2 (57%). Median time from first PCa diagnosis to NEPC diagnosis was 21 months; 44% of patients with NEPC had metastases prior to NEPC diagnosis. In a subpopulation of 1767 patients with NEPC diagnosed between 2014 and 2023-representing a more recent time period with contemporary treatments-the most frequently received treatments both before and after NEPC diagnosis were radiation (39% and 31%) and ADT (34% and 25%).

CONCLUSION

The findings of this study align with NEPC having a low real-world diagnostic prevalence among patients with PCa, especially in comparison to histology-based analyses, suggesting that treatment-induced NEPC may be underdiagnosed. This study underscores the need for further research in the NEPC population to advance diagnosis and treatment.