# Epidemiology, Comorbidities and Associated Treatments, Therapeutic Management, and Clinical Outcomes in Patients with Prostate Cancer in Spain (SRealProstate): A Real-World Cohort Study

## TL;DR

This study examines prostate cancer treatment and outcomes in Spain using real-world data from 19,224 patients, finding that advanced stages are linked to higher comorbidities and worse survival.

## Contribution

The study provides real-world insights into prostate cancer management and outcomes in Spain, highlighting stage-specific treatment patterns and survival disparities.

## Key findings

- Localized prostate cancer was most prevalent, with surgery and radiotherapy as common treatments.
- Advanced stages like mCRPC showed higher comorbidity rates and lower survival despite available therapies.
- Taxanes and androgen receptor pathway inhibitors were frequently used in advanced disease treatment.

## Abstract

Prostate cancer represents the most common cancer among men in Spain, with treatment approaches and outcomes varying markedly by disease stage. Real-world data from 19,224 patients in Spain were analyzed to assess prostate cancer management across disease stages, and to examine its impact on survival and health status. Early-stage disease was most frequently managed with surgery or radiotherapy, whereas advanced stages required more intensive therapies and were associated with a higher rate of comorbidities such as cardiovascular disease. Despite the availability of treatments, patients with advanced prostate cancer continue to experience reduced survival and greater health challenges. These findings underscore the need for improved strategies to enhance patient management across all stages of the disease.

Background/Objectives: Prostate cancer (PC) is the most prevalent cancer in men in Spain. Clinical management depends on the stage/tumor response to therapy/therapy availability. Given the limited national data, we analyzed real-world prevalence and management patterns. Methods: This was an observational, retrospective study using electronic medical records from public primary care centers/hospitals in Spain (BIG-PAC® database), between 1 June 2014, and 31 December 2021. Adult PC-diagnosed patients were classified into localized PC with no compromised lymph nodes and no metastasis (N0/M0), locally advanced PC with compromised lymph nodes, no metastasis (N1/M0), metastatic hormone-sensitive PC (mHSPC), non-metastatic castration-resistant PC (nmCRPC), and metastatic castration-resistant PC (mCRPC, categorized by treatment line). Progression across stages was recorded. All analyses were descriptive and exploratory. Results: A total of 19,224 patients met the inclusion criteria. The five-year PC prevalence was 590 cases/100,000 males; localized PC was the most prevalent form of cancer (PC[N0/M0]: 473/100,000; PC[N1/M0]: 78/100,000), followed by mCRPC (16/100,000), mHSPC (14/100,000), and nmCRPC (8/100,000). We further analyzed 5583 patients with progression. Surgery was performed in 61.7% PC (N1/M0), while radiotherapy was used in 24.3%. Taxanes were used in 52.4% of the mHSPC patients. First prescription options for mCRPC L1 and L2 were androgen receptor pathway inhibitors (55.9% and 49.7%); 44.9% of mCRPC L3 and 83.3% of L4+ (≥4 treatment lines) patients used taxanes. Analgesics were common in mHSPC, nmCRPC, and mCRPC patients. Few mHSPC patients died without progression (11.6%); 90.2% and 56.2% of the mCRPC patients received first- and second-line treatments, respectively. During follow-up, 2436 patients died. Cardiovascular comorbidities increased with stage. Conclusions: PC management in Spain varies substantially by disease stage. Advanced disease was associated with higher comorbidity burden and reduced survival in mHSPC and mCRPC patients, despite multiple available treatments.