Treatment Patterns and Outcomes in Patients With Metastatic Castration-resistant Prostate Cancer in a Real-world Clinical Practice Setting in the United States

Clin Genitourin Cancer. 2020 Aug;18(4):284-294. doi: 10.1016/j.clgc.2019.12.019. Epub 2020 Jan 7.


Background: Clinical trials have demonstrated the efficacy of several life-prolonging therapies for metastatic castration-resistant prostate cancer (mCRPC); however, real-world data on their use, survival effect, and safety are limited. Using electronic health record data from the Flatiron Health database, we studied real-world treatment patterns and health outcomes in patients with mCRPC.

Patients and methods: We conducted a retrospective, non-interventional cohort analysis of electronic health record data of patients with confirmed mCRPC between January 2013 and September 2017. The primary objective was to describe real-world treatment patterns, including treatment type, duration, and sequencing. Secondary objectives included describing patient characteristics and clinical outcomes.

Results: Of 2559 patients with mCRPC, 1980 (77%) received at least 1 line of life-prolonging therapy (abiraterone, enzalutamide, docetaxel, cabazitaxel, sipuleucel-T, or radium-223). Of patients receiving first-line therapy, 49% received second-line therapy, and of these, 43% received third-line therapy. Abiraterone/prednisone and enzalutamide accounted for 65% of first-line therapies and 54% of second-line therapies. Docetaxel was the most common third-line therapy (24%). Back-to-back use of abiraterone/prednisone and enzalutamide was common. Radium-223 monotherapy use was 2% in the first-line setting, 3% in the second-line setting, and 8% in the third-line setting. The median overall survival was longer in patients who received life-prolonging therapies (23.7 months; 95% confidence interval: 22.3-25.1 months) than in those who did not (10.1 months; 95% confidence interval: 9.1-11.5 months).

Conclusion: These real-world insights on over 2500 patients with mCRPC supplement findings from randomized controlled trials and may help to inform clinical trial design, treatment guidelines, and clinical decision-making.

Keywords: Community practice; Database; Electronic health record; Flatiron Health; Retrospective study.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Androstenes / administration & dosage
  • Antineoplastic Combined Chemotherapy Protocols / therapeutic use*
  • Benzamides / administration & dosage
  • Docetaxel / administration & dosage
  • Follow-Up Studies
  • Humans
  • Male
  • Nitriles / administration & dosage
  • Phenylthiohydantoin / administration & dosage
  • Prognosis
  • Prostatic Neoplasms, Castration-Resistant / drug therapy
  • Prostatic Neoplasms, Castration-Resistant / mortality*
  • Prostatic Neoplasms, Castration-Resistant / secondary
  • Retrospective Studies
  • Survival Rate
  • Taxoids / administration & dosage
  • Tissue Extracts / administration & dosage


  • Androstenes
  • Benzamides
  • Nitriles
  • Taxoids
  • Tissue Extracts
  • Docetaxel
  • Phenylthiohydantoin
  • cabazitaxel
  • sipuleucel-T
  • enzalutamide
  • abiraterone