Management and characteristics of patients with metastatic prostate cancer in a cohort of New Zealand men.

OBJECTIVE: This study aims to (1) characterise men diagnosed with metastatic prostate cancer, (2) describe their management and (3) look at their survival. METHODS: We identified patients registered with prostate cancer in the New Zealand Cancer Registry in the Midland Cancer Network region in 2009-2012 and examined these patients' clinical records to identify the metastatic cases. We investigated the patients' characteristics and the treatment pattern. All-cause survival was estimated by the Cox proportional hazards model. RESULTS: Of the 2,127 men diagnosed with prostate cancer, 234 (26 Maori/Pacific and 208 non-Maori/non-Pacific) were diagnosed with metastatic prostate cancer. After the diagnosis, 194 (82.9%) patients received androgen deprivation therapy (ADT), 5 had chemotherapy and 104 (44.4%) had radiotherapy. Of the patients treated with ADT, 46 (23.7%) had no monitoring prostate-specific antigen tests. Fifty-nine percent of the patients were alive after 12 months and 35% after 24 months. The hazard ratio for the Maori/Pacific men was 1.49. CONCLUSION: Overall, the survival of patients with metastatic prostate cancer was poor. There seems to be a strong case for the development of New Zealand guidelines on the management of metastatic disease including the use of first-line treatments, the ongoing monitoring for the development of castration-resistant prostate cancer (CRPC) and the treatment of CRPC.

Treatment modalities for Maori and New Zealand European men with localised prostate cancer.

OBJECTIVES: To examine diagnostic and treatment pathways for Maori (the indigenous people of New Zealand [NZ]) and NZ European men with prostate cancer in order to identify causes of higher mortality rates for Maori men. METHODS: All Maori men (150) diagnosed with prostate cancer in the Midland Cancer Network region between 2007 and 2010 were identified from the NZ Cancer Registry and frequency age-matched with three randomly sampled NZ European men. Clinical records of these men were searched for information on clinical stage at diagnosis, comorbidities, and type of treatment for localised disease. RESULTS: The final cohort included 136 Maori and 400 NZ European men, of whom 97 Maori and 311 NZ European were diagnosed with localised prostate cancer. Maori men were twice as likely to be diagnosed with distant metastases compared with NZ European men (19.1 vs 9.8 %). Maori men with localised disease were less likely to be treated with radical prostatectomy compared with NZ European men [RR 0.66 (95 % CI 0.48, 0.90)]. Multivariate regression analysis adjusted for age, D'Amico risk strata, comorbidities, and socioeconomic deprivation showed that Maori men were more likely to be managed expectantly [RR 1.74 (95 % CI 1.06, 2.57)]. CONCLUSION: Differences between Maori and NZ European men observed in the management of localised prostate cancer cannot be readily explained by patient characteristics, such as comorbidities or risk assessment at diagnosis. Poorer outcomes for Maori men may not only be related to later stage at diagnosis but differences in treatment modalities may also be a factor.

The Use of Androgen Deprivation Therapy (ADT) and Chemotherapeutic Agents in New Zealand Men with Prostate Cancer.

PURPOSE: To assess the patterns of use of androgen deprivation therapy (ADT) and chemotherapeutic agents in New Zealand men with prostate cancer. METHODS: Men diagnosed with prostate cancer between 2006 and 2011 were identified from the New Zealand Cancer Registry. Through data linkage with the Pharmaceutical Collection and the National Minimum Dataset information on subsidised anti-androgens, luteinising hormone-releasing hormone (LHRH) analogues, chemotherapeutic agents, and orchidectomy was retrieved. The frequency of ADT and chemotherapy use in the first year post-diagnosis was assessed by patients' age, ethnicity, and extent of disease at diagnosis. RESULTS: The study population included 15,947 men diagnosed with prostate cancer, of whom 4978 (31%) were prescribed ADT or chemotherapeutic agents. ADT was dispensed for 72% of men with metastatic disease. Only 24 (0.2%) men received chemotherapeutic agents. Men with advanced (regional or metastatic) disease older than 70 were more likely to receive anti-androgens only and to be treated with orchidectomy compared with younger men. Maori and Pacific men (compared with non-Maori/non-Pacific men) were more likely to receive pharmacologic ADT, and Maori men were also more likely to be treated with orchidectomy. CONCLUSIONS: It was expected that all men diagnosed with metastatic prostate cancer should be using ADT in the first year post-diagnosis. However, for more than one-fourth of men neither anti-androgens nor LHRH analogues were dispensed within this period. Chemotherapeutic agents were used very rarely, so it seems that both pharmacologic ADT and chemotherapy is under-utilised in New Zealand patients with advanced prostate cancer.