# Treatment-Free Survival and the Pattern of Follow-Up Treatments After Curative Prostate Cancer Treatment, a Real-World Analysis of Big Data from Electronic Health Records from a Tertiary Center

## TL;DR

This study uses real-world data to analyze treatment-free survival and follow-up treatments after curative prostate cancer therapies.

## Contribution

The study provides real-world insights into treatment-free survival and medication patterns following curative prostate cancer treatments.

## Key findings

- Treatment-free survival was highest for brachytherapy at 10 years.
- Multiple treatment lines occurred mainly in patients with low comorbidity scores.
- Medication profiles varied based on initial treatment type and treatment lines.

## Abstract

Background: Prospective trials provide robust evidence for prostate cancer (PCa) treatment but often include highly selective populations, limiting generalizability. Real-world data (RWD) can address these gaps and inform personalized care. Objectives: This study aimed to evaluate treatment-free survival (TFS) and secondary treatment sequences after initial curative therapy for PCa using electronic health record (EHR) data and to analyze associated medication profiles. Methods: We studied 3024 patients treated with radical prostatectomy (RP), brachytherapy (BT), or curative radiotherapy (RT) at Erasmus MC (2009–2023), the Netherlands. Outcomes included TFS, treatment sequences, and medication patterns across treatment lines. Results: Median age at diagnosis was 65 years (IQR 61–69) for RP, 68 (62–73) for BT, and 72 (68–76) for RT. At 10 years, TFS was 89% (95% CI: 84.9–94.1) for BT, 85% (95% CI: 83–87) for RT, and 71% (95% CI: 65.7–75.8) for RP. Most patients remained treatment-free, but up to five treatment lines occurred, mainly in patients with low comorbidity scores. Medication profiles reflected treatment-related morbidity: alpha-blocker use increased after BT and RT, while bladder relaxants were common after RP. Comorbidity-related medication use remained low among patients undergoing multiple sequenced treatments. Conclusions: These findings highlight the real-world application of multiple secondary treatments after different primary curative therapy options for PCa and associated comorbidity and medication use patterns. They confirm the durability and long-term effectiveness of curative treatments in real-world PCa care. By combining treatment trajectories and medication profiles, RWD provides insights for personalized counseling, helping clinicians and patients anticipate long-term treatment needs, and enabling informed decisions aligned with health status and preferences.