Prostate cancer progression: a scoping review, pharmacoeconomic assessment, and evaluation of quality of life.

AIMS/

BACKGROUND

Prostate cancer is the most common malignancy in men and a leading cause of cancer-related death. Progression from non-metastatic castration-resistant prostate cancer (nmCRPC) to metastatic CRPC (mCRPC) significantly worsens health-related quality of life (HRQoL), increases mortality, and raises healthcare costs. This study assessed the impact of avoiding or delaying progression to mCRPC on HRQoL, mortality, and economic outcomes, incorporating patients' lived experiences and unmet needs.

METHODS

Three complementary studies were conducted. Study 1 was a scoping review of HRQoL and functional outcomes across disease stages, analyzing 56 studies (27 RCTs, 29 observational). Study 2 used a pharmacoeconomic survival-partition model of apalutamide, calibrated for the Portuguese healthcare system, to estimate utility gains, mortality impacts, and healthcare costs associated with delaying progression (excluding drug costs). Study 3 comprised two virtual focus groups (n = 5) exploring patient experiences, including symptom burden, psychological impact, daily life disruption, coping strategies, and care-related unmet needs.

RESULTS

High-risk nmCRPC patients had higher HRQoL and better function than mCRPC patients. Symptomatic mCRPC had the lowest HRQoL (EQ-5D 0.63-0.90 vs 0.85-0.86; FACT-P 93-123 vs 109-121). Delaying progression yielded an estimated utility gain of 0.192, reduced annual mortality (0.1% vs 19.1%), and 4.4-fold lower healthcare costs. Focus groups confirmed greater physical symptoms, emotional distress, and social disruption in mCRPC, while nmCRPC experiences centered on monitoring and uncertainty. Patients identified gaps in supportive care, including psychosocial, sexual, and functional needs.

CONCLUSIONS

Delaying progression from nmCRPC to mCRPC confers substantial HRQoL, survival, and economic benefits. Patient perspectives highlight gaps in supportive care and the value of early targeted interventions.

LIMITATIONS: Small qualitative sample, reliance on baseline HRQoL without longitudinal adjustment, heterogeneity across studies, and exclusion of nmCRPC treatment costs may limit generalizability and precision.