World J Oncol

World Journal of Oncology, ISSN 1920-4531 print, 1920-454X online, Open Access

Article copyright, the authors; Journal compilation copyright, World J Oncol and Elmer Press Inc

Journal website https://www.wjon.org

Original Article

Volume 13, Number 6, December 2022, pages 350-358

Treatment Patterns Among Patients With Advanced Prostate Cancer in Brazil: An Analysis of a Private Healthcare System Database

Figure 1. Patient selection criteria. Twenty-seven patients fell into the exclusion criteria: incomplete treatment, defined as having no information on first-line treatment for mCRPC within the database, or patients whose mCRPC diagnosis was made more than 90 days before the first information on treatment. ICD: International Classification of Diseases; mCRPC: metastatic castration-resistant prostate cancer.

Figure 2. Sankey diagram of treatment pattern of patients with mCRPC (n = 168). AA: first-generation anti-androgen (bicalutamide or flutamide); ABI: abiraterone; ADT: androgen deprivation therapy; CAB: cabazitaxel; DOC: docetaxel; ENZA: enzalutamide; LOSS: information lost in tracking; mCRPC: metastatic castration-resistant prostate cancer.

Figure 3. Sankey diagram of treatment pattern of patients who were metastatic before mCRPC diagnosis (n = 122). AA: first-generation anti-androgen (bicalutamide or flutamide); ABI: abiraterone; ADT: androgen deprivation therapy; CAB: cabazitaxel; DOC: docetaxel; ENZA: enzalutamide; LOSS: information lost in tracking; mCRPC: metastatic castration-resistant prostate cancer.

Figure 4. Sankey diagram of treatment pattern of patients who were non-metastatic before mCRPC diagnosis (n = 45). AA: first-generation anti-androgen (bicalutamide or flutamide); ABI: abiraterone; ADT: androgen deprivation therapy; CAB: cabazitaxel; DOC: docetaxel; ENZA: enzalutamide; LOSS: information lost in tracking; mCRPC: metastatic castration-resistant prostate cancer.

**Table 1.** Patient Demographics and Baseline Characteristics
Characteristics	Patients with mCRPC (n = 168)
^aPatients might present ≥ 1 metastasis site. ADT: androgen deprivation therapy; IQR: interquartile range; mCRPC: metastatic castration-resistant prostate cancer.
Median age at diagnosis, years (IQR)	65.8 (59.2 - 71.4)
Median time between ADT and metastasis, years (IQR)	1.8 (1.0 - 4.9)
Stage at diagnosis, n (%)
I	0
II	7 (4.2)
III	2 (1.2)
IV	37 (22.0)
Unknown	122 (72.6)
Metastasis site^a, %
Bone	97.6
Lymph node	25.0
Lung	8.9
Liver	6.6
Bladder	4.2
Other	2.4

Table 1. Patient Demographics and Baseline Characteristics

Characteristics

Patients with mCRPC (n = 168)

^aPatients might present ≥ 1 metastasis site. ADT: androgen deprivation therapy; IQR: interquartile range; mCRPC: metastatic castration-resistant prostate cancer.

Median age at diagnosis, years (IQR)

65.8 (59.2 - 71.4)

Median time between ADT and metastasis, years (IQR)

1.8 (1.0 - 4.9)

Stage at diagnosis, n (%)

7 (4.2)

III

2 (1.2)

37 (22.0)

Unknown

122 (72.6)

Metastasis site^a, %

Bone

97.6

Lymph node

25.0

Lung

8.9

Liver

6.6

Bladder

4.2

Other

2.4

**Table 2.** First-Line Treatment and Cycle Characteristics in Patients With mCRPC
Variables	ABI	AA	CAB	DOC	ENZA
^aHigh disease volume was defined as the presence of visceral metastases or ≥ 4 bone lesions with ≥ 1 beyond the vertebral bodies and pelvis. AA: first-generation anti-androgen (bicalutamide or flutamide); ABI: abiraterone; ADT: androgen deprivation therapy; CAB: cabazitaxel; DOC: docetaxel; ENZA: enzalutamide; max: maximum; mCRPC: metastatic castration-resistant prostate cancer; min: minimum.
First-line treatment among patients with mCRPC, n (%)	56 (33.3)	27 (16.1)	3 (1.8)	60 (35.7)	22 (13.1)
Median duration between ADT and mCRPC diagnosis, months (min - max)	22.8 (13.2 - 44.4)	15.6 (8.4 - 24.0)	13.2 (12.0 - 115.2)	16.8 (8.4 - 32.4)	20.4 (16.8 - 45.6)
Disease volume, n (%)
High^a	11 (19.6)	3 (11.1)	2 (66.7)	12 (20.0)	4 (18.2)
Low	45 (80.4)	24 (88.9)	1 (33.3)	48 (80.0)	18 (81.8)
Metastasis status before the mCRPC diagnosis, n (%)
Metastatic	39 (69.6)	19 (70.4)	3 (100)	47 (79.7)	14 (63.6)
Non-metastatic	17 (30.4)	8 (29.6)	0	12 (20.3)	8 (36.4)

Table 2. First-Line Treatment and Cycle Characteristics in Patients With mCRPC

Variables

ABI

CAB

DOC

ENZA

^aHigh disease volume was defined as the presence of visceral metastases or ≥ 4 bone lesions with ≥ 1 beyond the vertebral bodies and pelvis. AA: first-generation anti-androgen (bicalutamide or flutamide); ABI: abiraterone; ADT: androgen deprivation therapy; CAB: cabazitaxel; DOC: docetaxel; ENZA: enzalutamide; max: maximum; mCRPC: metastatic castration-resistant prostate cancer; min: minimum.

First-line treatment among patients with mCRPC, n (%)

56 (33.3)

27 (16.1)

3 (1.8)

60 (35.7)

22 (13.1)

Median duration between ADT and mCRPC diagnosis, months (min - max)

22.8 (13.2 - 44.4)

15.6 (8.4 - 24.0)

13.2 (12.0 - 115.2)

16.8 (8.4 - 32.4)

20.4 (16.8 - 45.6)

Disease volume, n (%)

High^a

11 (19.6)

3 (11.1)

2 (66.7)

12 (20.0)

4 (18.2)

Low

45 (80.4)

24 (88.9)

1 (33.3)

48 (80.0)

18 (81.8)

Metastasis status before the mCRPC diagnosis, n (%)

Metastatic

39 (69.6)

19 (70.4)

3 (100)

47 (79.7)

14 (63.6)

Non-metastatic

17 (30.4)

8 (29.6)

12 (20.3)

8 (36.4)

**Table 3.** Treatment Received Before mCRPC Diagnosis (n = 167)
Treatment	All patients, n (%)	Classification before mCRPC diagnosis, n (%)
AA: first-generation anti-androgen (bicalutamide or flutamide); ABI: abiraterone; ADT: androgen deprivation therapy; DOC: docetaxel; mCRPC: metastatic castration-resistant prostate cancer.
ABI	8 (4.8)	8 (6.6)	0
DOC	20 (12.0)	17 (13.9)	3 (6.7)
ADT	85 (50.9)	62 (50.8)	23 (51.1)
ADT + AA	54 (32.3)	35 (28.7)	19 (42.2)
Total	167 (100)	122 (100)	45 (100)

Table 3. Treatment Received Before mCRPC Diagnosis (n = 167)

Treatment

All patients, n (%)

Classification before mCRPC diagnosis, n (%)

Metastatic

Non-metastatic

AA: first-generation anti-androgen (bicalutamide or flutamide); ABI: abiraterone; ADT: androgen deprivation therapy; DOC: docetaxel; mCRPC: metastatic castration-resistant prostate cancer.

ABI

8 (4.8)

8 (6.6)

DOC

20 (12.0)

17 (13.9)

3 (6.7)

ADT

85 (50.9)

62 (50.8)

23 (51.1)

ADT + AA

54 (32.3)

35 (28.7)

19 (42.2)

Total

167 (100)

122 (100)

45 (100)

**Table 4.** First-Line Treatment for mCRPC According to Treatment Received Immediately Before mCRPC Diagnosis
Treatment received immediately before mCRPC diagnosis	First-line treatment, n (%)
AA: first-generation anti-androgen (bicalutamide or flutamide); ABI: abiraterone; ADT: androgen deprivation therapy; CAB: cabazitaxel; DOC: docetaxel; ENZA: enzalutamide; mCRPC: metastatic castration-resistant prostate cancer.
ADT + ABI (n = 8)	0	0	1 (33.3)	5 (8.5)	2 (9.1)
ADT + AA (n = 48)	21 (32.5)	0	0	21 (35.6)	6 (27.3)
ADT + DOC (n = 18)	9 (16.1)	1 (3.7)	2 (66.7)	1 (1.7)	5 (22.7)
ADT + ENZA (n = 1)	0	0	0	1 (1.7)	0
ADT monotherapy (n = 92)	26 (46.4)	26 (96.3)	0	31 (52.5)	9 (41.0)
Total	56 (100)	27 (100)	3 (100)	59 (100)	22 (100)

Table 4. First-Line Treatment for mCRPC According to Treatment Received Immediately Before mCRPC Diagnosis

Treatment received immediately before mCRPC diagnosis

First-line treatment, n (%)

ABI

CAB

DOC

ENZA

AA: first-generation anti-androgen (bicalutamide or flutamide); ABI: abiraterone; ADT: androgen deprivation therapy; CAB: cabazitaxel; DOC: docetaxel; ENZA: enzalutamide; mCRPC: metastatic castration-resistant prostate cancer.

ADT + ABI (n = 8)

1 (33.3)

5 (8.5)

2 (9.1)

ADT + AA (n = 48)

21 (32.5)

21 (35.6)

6 (27.3)

ADT + DOC (n = 18)

9 (16.1)

1 (3.7)

2 (66.7)

1 (1.7)

5 (22.7)

ADT + ENZA (n = 1)

1 (1.7)

ADT monotherapy (n = 92)

26 (46.4)

26 (96.3)

31 (52.5)

9 (41.0)

Total

56 (100)

27 (100)

3 (100)

59 (100)

22 (100)