Epidemiology of castration resistant prostate cancer: A longitudinal analysis using a UK primary care database |
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| Authors: | C.J. Hirst C. Cabrera M. Kirby |
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| Affiliation: | 1. Global Epidemiology, AstraZeneca, Alderley Park, Cheshire, UK;2. Global Epidemiology, AstraZeneca, Molndal, Sweden;3. The Prostate Centre and Faculty of Health and Human Sciences, Centre for Research in Primary and Community Care, University of Hertfordshire, UK;1. Department of Urology, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany;2. The Institute of Cancer Research and The Royal Marsden Hospital, Sutton, Surrey, UK;3. Department of Cancer Medicine, Institut Gustave Roussy, University of Paris Sud, Villejuif, France;4. Department of Surgery, Division of Urology, Center for Integrated Research on Cancer and Lifestyle, Samuel Oschin Comprehensive Cancer Center, Cedars-Sinai Medical Center, Los Angeles, CA, USA;5. Section of Urology, Durham VA Medical Center, Durham, NC, USA;6. Library for the Medical Faculty of Mannheim, University of Heidelberg, Mannheim, Germany;7. Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA;8. Department of Medical Oncology, GU section, Dana-Farber Cancer Institute, Boston, MA, USA;9. Department of Medical Oncology, San Camillo and Forlanini Hospitals, Rome, Italy;10. Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, School of Medicine, Baltimore, MD, USA;11. Department of Urology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, School of Medicine, Baltimore, MD, USA;1. Department of Clinical Oncology, St James''s Institute of Oncology, St James''s University Hospital, Leeds, UK;2. Departments of Clinical Oncology and Nuclear Medicine, Castle Hill Hospital, Cottingham, UK;3. Department of Clinical Oncology, Weston Park Hospital, Sheffield, UK;1. Department of Oncology, McMaster University and Escarpment Cancer Research Institute, Hamilton, Ontario, Canada;2. UAB Comprehensive Cancer Center, Birmingham, AL, USA;3. Erasmus University Medical Centre, Rotterdam, The Netherlands;4. Johns Hopkins University, Baltimore, MD, USA;5. Princess Margaret Hospital, Toronto, Canada;6. Duke Cancer Institute and the Duke Prostate Center, Duke University, Durham, NC, USA;1. Departamento de Urología, Hospital Universitario Central de Asturias, Oviedo, España;2. Departamento de Urología, Hospital Virgen de las Nieves, Granada, España;3. Departamento de Urología, Hospital Morales Meseguer, Murcia, España;4. Departamento de Urología, Hospital Clínico, Salamanca, España;5. Departamento de Urología, Hospital Universitario 12 de Octubre, Madrid, España;11. Complexo Hospitalario Universitario A Coruña (CHUAC), A Coruña, España;22. Hospital Regional Universitario Carlos Haya, Málaga, España;33. Fundación Puigvert, Barcelona, España;44. Hospital de Basurto, Bilbao, España;55. Hospital Clínic i Provincial de Barcelona, Barcelona, España;66. Hospital Clínico Universitario de Valencia, Valencia, España;77. Hospital Clínico Universitario Lozano Blesa, Zaragoza, España;88. Hospital General Universitario de Alicante, Alicante, España;99. Hospital General Universitario Gregorio Marañón, Madrid, España;1010. Hospital General Universitario Morales Meseguer, Murcia, España;1111. Hospital Universitario 12 de Octubre, Madrid, España;1212. Hospital Universitario Central de Asturias, Oviedo, España;1313. Hospital Universitario de Bellvitge, L’Hospitalet de Llobregat, España;1414. Hospital Universitario de Canarias, Tenerife, España;1515. Hospital Universitario Infanta Cristina, Madrid, España;pp. Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, España;qq. Hospital Universitario Ramón y Cajal, Madrid, España;rr. Hospital Universitario Reina Sofía, Córdoba, España;ss. Hospital Universitario Río Hortega, Valladolid, España;tt. Hospital Universitario Virgen del Rocío, Sevilla, España;uu. Hospital Universitario Virgen Macarena, Sevilla, España;vv. Hospital Universitario Vall d’Hebron, Barcelona, España;ww. Hospital Virgen de las Nieves, Granada, España;xx. Hospital Virgen de la Salud, Toledo, España;1. Memorial Sloan-Kettering Cancer Center and Weill Cornell Medical College, New York, NY, USA;2. Harvard Medical School and Massachusetts General Hospital, Boston, MA, USA;3. The Institute of Cancer Research and Royal Marsden NHS Foundation Trust, Sutton, Surrey, UK;4. MD Anderson Cancer Center, Houston, TX, USA;5. Carolina Urologic Research Center, Atlantic Urology Clinics, Myrtle Beach, SC, USA;6. University of Western Sydney School of Medicine, Penrith, Australia;7. Institut Gustave Roussy, University of Paris Sud, Villejuif, France;8. Radboud University Medical Centre, Nijmegen, The Netherlands;9. Hematology & Oncology Clinics of Australia, Brisbane, Australia;10. Sarah Cannon Research Institute, Nashville, TN, USA;11. Oregon Health & Science University Knight Cancer Institute, Portland, OR, USA;12. Cross Cancer Institute, Edmonton, Alberta, Canada;13. Laval University, Québec City, Québec, Canada;14. University Hospital Leuven, Leuven, Belgium;15. Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain;p. University of Colorado Cancer Center and University of Colorado School of Medicine, Aurora, CO, USA;q. University of Washington, Fred Hutchinson Cancer Research Center, Seattle, WA, USA;r. Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA;s. Janssen Research & Development, Los Angeles, CA, USA;t. Janssen Research & Development, Raritan, NJ, USA;u. Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA, USA;v. Janssen Research & Development, Menlo Park, CA, USA;w. CRCHUM, University of Montréal, Montréal, Québec, Canada;1. Bristol Haematology and Oncology Centre, University Hospitals Bristol NHS Foundation,UK;2. Rosemere Cancer Centre, Lancashire Teaching Hospitals, Preston, UK;3. Guy''s and St Thomas'' NHS Foundation Trust, London, UK;4. The Institute of Cancer Research and Royal Marsden NHS Foundation Trust, Sutton, UK |
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| Abstract: | Background: Castration resistant prostate cancer (CRPC) is defined clinically as a failure of castration to prevent an increase in circulating hormones which are associated with worsening prostate cancer. Published information on the frequency and characteristics of CRPC patients are lacking. This may be partly because there is no specific code which doctors can use to record CRPC, making research in existing data sources such as the General Practice Research Database (GPRD) difficult. Methods: The aim of this study was to firstly develop a method to accurately and thoroughly identify CRPC patients in the GPRD, using a combination of codes for treatments and diagnostic tests which these patients are likely to have received. Secondly, the anonymised electronic medical records were used to study the identified CRPC patient characteristics, such as age, treatments, comorbidity and expected survival. Results: After comprehensive exploratory research, the final algorithm was selected to identify patients’ assumed recording on the GPRD of either a rising prostate specific antigen (PSA) value (clinical definition of CRPC) or evidence of a switch in treatment after castration. Using the algorithm, over the 1999–2009 study period, 11 600 castrated prostate cancer patients were identified. Of these, 3277 (28%) developed CRPC during the study period, with an incidence rate of 8.3 per 100 person years in castrated prostate cancer patients, and 3.8 per 100 person years in all prostate cancer patients. Mean patient age at CRPC was 76.8 years, and mean survival duration from CRPC status was 13.5 months, and from first prostate cancer diagnosis was 48.2 months. The most common comorbidities among CRPC patients were hypertension, dyspnoea, and anaemia. Conclusions: Sensitivity analyses to test algorithms with differing inclusion criteria suggested that the primary algorithm was robust, reducing bias through missing data, while avoiding ‘false positives’ and retaining clinical credibility. Overall, our study has documented a reliable method for identifying CRPC patients in GPRD, and thus we have been able to characterise these patients more accurately. |
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