PSA Outcomes and Clinical Surveillance Among Patients With Nonmetastatic Castration-Resistant Prostate Cancer Treated With a Next-Generation Androgen Receptor Inhibitor in Urology Practices With or Without In-Office Dispensing

This retrospective study used electronic medical record data from community-based urology practices in the US (February 1, 2017, to September 17, 2021) to describe prostate-specific antigen (PSA) outcomes and clinical sur­veillance patterns among patients with nonmetastatic castration-resistant pros­tate cancer (nmCRPC) receiving next-generation androgen receptor inhibitors (ARIs) with or without in-office dispensing (IOD) services. Patients who were prescribed apalutamide, darolutamide, or enzalutamide were classified in IOD+ (IOD access + fill), IOD– (IOD access + no fill), or non-IOD cohorts (no IOD ac­cess). Outcomes were described by cohort from 14 days following initial prescrip­tion to the earliest of initiation of a new ARI or advanced prostate cancer medi­cation, end of clinical activity, or end of data availability. In total, 3300 patients were included (IOD+: n = 615; IOD–: n = 2474; non-IOD: n = 211). PSA response defined as a decline ≥50% from the baseline PSA value (PSA50) achieved by 6 and 12 months was observed in 80.0% and 83.8% of patients in the IOD+ cohort, 63.8% and 72.3% in the IOD– cohort, and 62.5% and 69.1% in the non-IOD cohort. Patients in the IOD+ cohort underwent fewer bone scans, computerized tomog­raphy, and next-generation imaging than IOD– and non-IOD cohorts and also had longer time from treatment initiation to first follow-up imaging. IOD services may better support comprehensive disease management for patients with nmCRPC receiving next-generation ARIs and may be associated with better long-term clin­ical outcomes.