Surgical Castration as an Alternative to Improve Systemic Treatment for Advanced Prostate Cancer: A Window of Opportunity for Developing Countries.

Autor:	Monteiro FSM; Latin American Cooperative Oncology Group-LACOG, Porto Alegre, Brazil.; Hospital Sirio Libanês, Brasilia, Brazil., Sasse AD; Grupo SONHE, Campinas, Brazil., Araujo DV; Medical School at the State University of Rio de Janeiro, Rio de Janeiro, Brazil., McKay RR; University of California San Diego, La Jolla, CA., da Trindade KM; Latin American Cooperative Oncology Group-LACOG, Porto Alegre, Brazil.; Oncologia D'Or, Fortaleza, Brazil., Soares A; Latin American Cooperative Oncology Group-LACOG, Porto Alegre, Brazil., Alves JR; Hospital de Base do Distrito Federal, Brasilia, Brazil., Valverde DA; Techtrials Pesquisa e Tecnologia Ltda, São Paulo, Brazil., Bastos DA; Latin American Cooperative Oncology Group-LACOG, Porto Alegre, Brazil.; Hospital Sirio Libanês, São Paulo, Brazil., James ND; Institute of Cancer Research, London, United Kingdom., Herchenhorn D; Latin American Cooperative Oncology Group-LACOG, Porto Alegre, Brazil.; University of California San Diego, La Jolla, CA.; Instituto D'Or de Ensino e Pesquisa-IDOR, Rio de Janeiro, Brazil.
Jazyk:	angličtina
Zdroj:	JCO global oncology [JCO Glob Oncol] 2024 Nov; Vol. 10, pp. e2400319. Date of Electronic Publication: 2024 Nov 14.
DOI:	10.1200/GO-24-00319
Abstrakt:	Purpose: The Brazilian Public Health System (BPHS) serves approximately 71,730 patients with prostate cancer (PC) every year for which androgen deprivation therapy (ADT) is the primary treatment for patients with advanced hormone-sensitive prostate cancer (aHSPC). Androgen receptor pathway inhibitors (ARPIs) are not accessible through the BPHS. Using the BPHS as a model, this study assesses the long-term economic effect of surgical versus medical castration in aHSPC treatment to strategize cost reduction and the incorporation of ARPI in developing countries. Patients and Methods: Data of patients with aHSPC (ie, TxN1M0 ineligible for local treatment or TxNxM1) from the BPHS database were analyzed from January 1, 2011, to December 31, 2021, using the TECHTRIALS artificial intelligence platform. The main outcomes were quantitative and descriptive analyses as well as a cost analysis of surgical versus chemical castration. Results: Of the 274,519 patients with aHSPC who received active treatment during the 11-year study period, 90% (n = 246,683) underwent chemical castration and 10% (n = 27,836) underwent bilateral subcapsular orchiectomy (BSO). The median duration of chemical castration was 28 months. The BPHS spent an estimated total of $665,552,091.40 US dollars (USD) on chemical castration and $5,939,348.47 USD on BSO, respectively. The cost per patient was $2,698 USD and $213.37 USD for chemical castration and BSO, respectively. Hypothetically, if all patients with aHSPC had undergone BSO, the total direct cost for the BPHS would have been $42,774,832.20 USD, saving $622,777,259.20 USD over 11 years, making it possible to offer low-dose abiraterone to 65% of aHSPC patients. Conclusion: On the basis of this extensive financial analysis from the world's largest public health system database, BSO appears to be a valuable alternative to chemical castration for treating aHSPC. In resource-limited environments, the cost savings from using BSO may allow access to drugs that will improve survival such as ARPIs.
Databáze:	MEDLINE
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