UPJ INSIGHT: Prescribing Differences Between Urologists and Medical Oncologists in Advanced Prostate Cancer
By: Timothy Demus, DO, MSc; Robert H. Getzenberg, PhD; Alan M. Nieder, MD | Posted on: 16 Feb 2023
Study Need and Importance
U.S. practitioners treating advanced prostate cancer patients are increasingly prescribing secondary hormonal agents in the nonmetastatic and metastatic hormone sensitive disease states. In this study, we aimed to better understand evolving urological practice by comparing prescribing patterns of urologists to medical oncologists as well as looking at regional variations in prescriptions of 2 of the hormonal agents, enzalutamide and abiraterone.
What We Found
In 2017 and 2019 (before and after broadened Food and Drug Administration approved indications), urologists were more likely to prescribe enzalutamide over abiraterone compared to medical oncologists (OR 3.38, CI 2.84-4.02, P < .001 and OR 4.91, CI 4.22-5.74, P < .001, respectively). In 2019, urologists and medical oncologists practicing in the Southeast and Pacific West were more likely to prescribe enzalutamide; however, this pattern was not observed in 2017. Urologists prescribing enzalutamide and abiraterone at a higher volume (≥60 prescriptions of either drug) favored prescriptions of abiraterone, as demonstrated in the Figure. The proportion of abiraterone prescribed as generic was 37.9% and 62.5% for urologists and medical oncologists, respectively.
The study used a provider-level Medicare Part D data set and could not capture whether abiraterone and enzalutamide were prescribed concurrently or if one was prescribed because the patient had progressed on or had significant side effects on the other, which may have influenced prescribing decisions.
Interpretation for Patient Care
Despite guidelines recommending either agent, urologists are more likely to prescribe enzalutamide to metastatic castration-resistant prostate cancer patients. There are regional variations in prostate cancer management with relatively more nonmetastatic castration-resistant patients receiving an antiandrogen in the Southeast and Pacific West. Urologists should be cognizant of generic versions of secondary hormonal drugs as well as newer agents as they become commercially available.