New findings from a study of the prevalence and natural history of nonmetastatic castration-resistant prostate cancer (nmCRPC) may provide a benchmark to gauge potential benefits of novel imaging and therapies, prostate cancer, investigators reported at the ASCO Genitourinary Cancers Symposium 2022.

Investigators identified a real-world Canadian cohort diagnosed with nmCRPC from 2007 to early 2018 prior to the introduction of novel anti-androgen agents, such as enzalutamide, apalutamide, and darolutamide. The cohort included 2045 patients with a castration level of testosterone (less than 1.7 nmol/L) who experienced rising PSA (beyond 2.0 nmol/L with a more than 25% increase from the nadir) to a median 3.0 ng/L and met criteria for nmCRPC.

On average, 8% of men with prostate cancer receiving androgen deprivation therapy (ADT) had nmCRPC each year, Amanda Elizabeth Hird, MD, of the University of Toronto, Toronto, Ontario, Canada, reported on behalf of her team. A total of 984 patients (48.1%) had received upfront hormonal therapy, 584 (25.8%) had received initial radiation therapy, and 478 (23.4%) underwent radical prostatectomy. Median time from primary treatment to nmCRPC was 6 years, she said.

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The time from nmCRPC to all-cause death was a median 37.6 months, Dr Hird reported. Metastasis developed in 20% of men with nmCRPC at a median 31.1 months. The median time to metastasis and from metastasis to all-cause death was 20.0 and 8.3 months, respectively.

Using regression analysis, the investigators identified the following predictors of a shorter time to prostate cancer death: older age, higher PSA at nmCRPC diagnosis, and grade group 4-5 disease.

“The current study can be used as a historical cohort to compare how novel imaging modalities and advancements in systemic therapy for patients with nmCRPC impact prevalence estimates and disease trajectory over time,” Dr Hird said.


Hird AE, Dvorani E, Saskin R, Herschorn S, Kodama R, Kulkarni GS, Nam R. Prevalence and natural history of non-metastatic castrate resistant prostate cancer: A population-based analysis. Paper presented at: ASCO Genitourinary Cancers Symposium; February 17-19, 2022. Abstract 65.