Shorter PSA doubling time (PSADT) is associated with shorter metastasis-free and overall survival in US veterans with nonmetastatic castration-resistant prostate cancer (nmCRPC), according to a new study.

An analysis of data from 12,083 patients with nmCRPC receiving care within the Veterans Health Administration system showed that patients with a PSADT of 15 months or more had a significant 69% and 63% lower risk of metastasis and death, respectively, compared with those who had a PSADT of less than 3 months, Stephen J. Freedland, MD, of Cedars-Sinai Medical Center in Los Angeles, and colleagues reported in Urologic Oncology.

Patients who progressed to metastatic disease had a 3-fold higher risk of death compared with those who did not, “reiterating the importance of delaying the occurrence of metastasis to improve the prognosis of patients with nmCRPC,” according to the investigators.

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In addition, the study found that health resource utilization increased following onset of nmCRPC and progression to metastatic castration-resistant prostate cancer (mCRPC). Mean inpatient stays increased from 0.2 to 0.5 per-patient-per-year (PPPY) following onset of nmCRPC and from 0.6 to 2.8 PPPY following onset of mCRPC. Healthcare costs also increased, with mean pharmacy costs more than tripling following development of nmCPRC ($2074 vs $6839). Mean healthcare costs rose sharply when men progressed from nmCRPC to mCRPC: Inpatient costs increased from $7257 to $61,691 PPPY, emergency department costs increased from $844 to $1958 PPPY, and pharmacy costs increased from $4115 to $26,279 PPPY, according to the investigators.

Dr Freedland and his collaborators said their findings of a pronounced increase in healthcare costs following progression to mCRPC suggest that “delaying the onset of metastasis with newly approved antiandrogens may lead to savings, or at least delays, in medical costs, although this has yet to be formally tested.”


Several study authors are employees of Analysis Group Inc., a consulting company that has received research grants from Janssen Scientific Affairs to conduct this study. One author was an employee of Janssen Scientific Affairs at the time of the study and another author is a consultant for Janssen Scientific Affairs.


Freedland SJ, Pilon D, Bhak RH, et al. Predictors of survival, healthcare utilization, and healthcare costs in veterans with non-metastatic castration-resistant prostate cancer. Urol Oncol. Published online July 30, 2020. doi:10.1016/j.urolonc.2020.07.002