Mortality in Medicare-aged Men with Metastatic Prostate Cancer After the Introduction of Androgen Receptor Pathway Inhibitors: A Population-Based Study.

Publication/Presentation Date

8-4-2026

Abstract

OBJECTIVE: To examine mortality and usage changes after the introduction of androgen receptor pathway inhibitors (ARPI) among older patients with metastatic prostate cancer covered by Medicare.

MATERIALS AND METHODS: The study cohort, consisting of patients newly diagnosed with mPCa, was identified from the Surveillance, Epidemiology, and End Results (SEER)-Medicare Linked Database. The primary outcome was all-cause mortality with time zero at date of mPCa diagnosis. Patients were classified as pre-ARPI era if diagnosed with mPCa in 2006-2012 and ARPI era if diagnosed in 2013-2019. Mortality was summarized by unadjusted cumulative incidence and evaluated using covariate adjusted mortality hazard ratios (aHRs) from Cox proportional hazards regression modeling.

RESULTS: This study included 9,625 patients diagnosed with mPCa (median age 78 years). 44.3% of patients with Medicaid Part D coverage were prescribed therapies in the ARPI era. Stratification by stage revealed that patients with M1a and M1b disease experienced significantly decreased mortality (aHRs: M1a 0.77, 95% CI 0.60-0.98, p=0.03; M1b 0.81, 0.77-0.86, p< 0.01; M1c 0.90, 0.80-1.01; p=0.06).

CONCLUSIONS: Since the introduction of ARPIs, the uptake among Medicare patients was relatively high. While we observed a significant 20% lower mortality hazard among patients diagnosed with mPCa after 2013 when ARPIs were introduced, some of the improvement might have resulted from stage migration.

ISSN

1527-9995

Disciplines

Business Administration, Management, and Operations | Health and Medical Administration | Management Sciences and Quantitative Methods

PubMedID

42551541

Department(s)

Administration and Leadership

Document Type

Article

Link to Full Text

Share

COinS