Sufficient evidence and international guidelines support the use of Bone-Targeted Agents (BTA) in metastatic prostate cancer (mPC) in alleviating the risk of skeletal-related events (SREs) as a consequence of bone metastasis. However, BTA utilization pattern in Asian mPC patients remains undetermined. A survey was conducted to evaluate the current practice of BTA in Hong Kong.
This survey consisted of 20 questions with multiple choice answers, covering patient characteristics, practice preference and factors influencing the use of BTA for mPC. The survey was posted online and sent to HKSUO members, including oncologists and urologists in public and private sectors in Hong Kong. The survey was started since Jan 2020 and filled anonymously with password provided by HKSUO.
30 clinicians (oncologists, 77%; urologists, 23%) completed the survey, with >50% practicing in public hospitals. Majority of the mPC patients had bone metastasis, with only 23% respondents reported <25% of their patients with bone metastasis. Diagnostic imaging for bone metastasis was considered for newly diagnosed prostate cancer when PSA level was high (57%), or patients presented with bone pain (34%). 74% of the respondents considered ≤1 week of waiting time for the imaging was optimal, however, only 40% of their patients has done so. BTA was considered as one of the treatment components (77%), with the primary goal for SRE prevention (73%). Clinicians tend to reserve BTA in patients with higher burden of bone metastasis (6-10 bone metastasis,27%; >10 bone metastasis, 40%). Efficacy (44%) and cost (33%) were the major considerations in selecting BTA. Denosumab was the preferred BTA (63%), while the average duration of treatment was >1 year (70%).
Our interim analysis shows BTA may be underutilized for Asian mPC patients in real-life setting. Approximately 1/4 of the respondents did not consider BTA in their treatment plan, albeit understanding its primary goal in SRE prevention. The misconception regarding the benefit of BTA limited in higher burden of disease may be the potential barriers. There seems to be an unmet need in the awareness of optimal use of BTA in mPC.
Clinical trial identification
Legal entity responsible for the study
Hong Kong Society of Uro-Oncology.
All authors have declared no conflicts of interest.