Ajay S. Behl

Assessment of Evidence-Based Standards in the Treatment of Advanced Prostate Cancer in a Community Practice

Introduction: Although the monitoring of patients with advanced prostate cancer is essential to optimize treatment, little is known about adherence to guidelines. In this study we compared testing practices at an integrated urology/radiation oncology group practice with evidence‐based guidelines and best practices. Methods: Electronic medical records up to December 2014 from the integrated urology/radiation oncology group practice were queried to identify patients who received androgen deprivation therapy and in whom advanced disease was staged as androgen deprivation therapy sensitive, subcastration resistant (incompletely defined probable castration resistant prostate cancer) or castration resistant after April 2011 and for 6 months or more. Frequency of prostate specific antigen and testosterone level testing as well as imaging (magnetic resonance imaging, computerized tomography, positron emission tomography/computerized tomography, bone scan or x‐ray) was evaluated, and compared to national guidelines and best practices. Results: Overall 346 patients with androgen deprivation therapy sensitive prostate cancer, 90 with subcastration resistant prostate cancer and 102 with castration resistant prostate cancer met the study inclusion criteria. On average, prostate specific antigen was tested every 4.7, 3.7 and 3.3 months for patients with androgen deprivation therapy sensitive disease, subcastration resistant prostate cancer and castration resistant prostate cancer, respectively, compared with the 3 to 12 months and 3 months recommendations of the National Comprehensive Cancer Network and RADAR (Prostate Cancer Radiographic Assessments for Detection of Advanced Recurrence) for patients with androgen deprivation therapy sensitive disease and nonmetastatic castration resistant prostate cancer, respectively. Testosterone levels were assessed within 6 months of classification for 23% and 46% of patients with subcastration resistant prostate cancer and castration resistant prostate cancer, respectively. Finally, 28% and 46% of patients with subcastration resistant prostate cancer and castration resistant prostate cancer, respectively, underwent some type of imaging within 6 months. Conclusions: This retrospective study of patients receiving androgen deprivation therapy at a particular integrated urology/radiation oncology group practice demonstrated adherence to prostate specific antigen best practices. However, there was some room for improvement in terms of testosterone testing and imaging.

PD37-04 STATINS AND ORAL TREATMENTS IN PATIENTS WITH METASTATIC CASTRATION RESISTANT PROSTATE CANCER (MCRPC): REAL-WORLD OUTCOMES

ascertained at least 180 days after prostate cancer diagnosis. We used 1:1 propensity scoreematched analysis ,multivariable-adjusted Cox proportional hazards models to investigate the association between ADT use and the risk of autoimmune diseases RESULTS: Of the 17,168 selected prostate cancer patients, 16,379 patients were met our inclusion and exclusion criteria, with 7,025 receiving ADT and 9,354 were no-ADT users. After 1:1 propensity score matching, there were 5,590 ADT users and 5,590 nonADT users in the study cohort. During a mean follow-up period of 5.1 years, 457 patients were newly diagnosed with autoimmune diseases with 155 among ADT users and 302 among non-ADT users. KaplanMeier curves demonstrated a higher cumulative probability of remaining autoimmune diseases-free among ADT users (Figure 1). Compared to non-ADT users, ADT group was statistically associated with a decreased risk of autoimmune diseases (adjusted hazard ratio (HR) 0.63, 95%CI 0.52-0.76) after Cox proportional hazards models. More specially, ADT users had a decreased risk of Graves’ disease (aHR 0.46, 95%CI 0.23-0.91), psoriasis (aHR 0.53, 95%CI 0.29-0.97), type 1 diabetes (aHR 0.33, 95%CI 0.17-0.63), and uveitis (aHR 0.51, 95%CI 0.26-0.97) (Table 1). CONCLUSIONS: The result of this study indicated that ADT use in patients with prostate cancer may decrease the risk of autoimmune diseases, especially in Graves’ disease, psoriasis, type 1 diabetes, and uveitis. Further studies are warranted to further investigation to obtain a better understanding between ADT and autoimmune diseases.

Prevalence of glucocorticoid use in prostate cancer patients.

336 Background: The prevalence of glucocorticoid (GC) use increases with age consistent with age-acquired diseases such as chronic obstructive pulmonary and inflammatory conditions for which GCs are indicated. GCs are commonly used alone or in combination with other therapies for prostate cancer (PC), but studies of GC treatment patterns in treated and untreated PC patients (pts) have not been widely reported. This study aimed to describe the prevalence of GC use in PC. Methods: Patients with ≥ 2 PC diagnoses or ≥1 claim for a PC therapy and ≥ 12 months continuous eligibility between 1/2005 and 7/2014 were identified in Truven Health MarketScan databases. The index date for the treated cohort (i.e., pts receiving LHRH agonist, adrenal blocker, anti-androgen, chemotherapy, oral mCRPC therapy, surgery or radiation) was defined as the date of the most recent PC treatment. The index date for the untreated cohort (i.e., with PC diagnosis but without PC treatment) was defined as the most recent PC diagnosis dat...

Gaps in treatment amongst metastatic castration resistant prostate cancer (mCRPC) patients taking abiraterone acetate or enzalutamide.

334 Background:Abiraterone acetate (ABI) and enzalutamide (ENZ) are novel oral therapies offering survival benefit to metastatic castration-resistant prostate cancer (mCRPC) patients. The efficacy of cancer treatments rely on patient consistency and adherence to recommended dosage regimens. Factors such as drug-drug interactions and intolerance or toxicities can result in patients or their providers reducing the drug dosage. This study aims to describe treatment discontinuation patterns observed for ABI and ENZ. Methods: The Truven Health MarketScan Research Databases were used to conduct a retrospective analysis of mCRPC patients initiated on ABI or ENZ (index date) between 10/01/2012 to 12/31/2014 with ≥6 months of continuous eligibility prior to index date and a PC diagnosis during the period of continuous eligibility. Patients were observed until loss to follow-up, or end of data availability. Kaplan-Meier (KM) survival curves were used to compare the rates of having a refill gap (i.e., ≥14 days, ≥30 ...