Hormonal therapy is the mainstay of prostate cancer, in all stages of disease and clinical settings. The adoption of novel hormonal agents, Zytiga (Johnson & Johnson/Janssen) and Xtandi (Pfizer/Astellas), for metastatic castrate-resistant disease has driven considerable growth in the size of the prostate cancer market. Penetration of Zytiga and Xtandi (and other novel hormonal agents) in other patient populations (e.g., biochemical recurrent, non-metastatic castrate-resistant disease) will be major market drivers. Other therapies, including Xofigo (Bayer HealthCare) and Jevtana (Sanofi) offer non-hormonal treatment options. However, optimal sequencing of therapies in the crowded castrate resistant prostate cancer armamentarium is still under reconnaissance.

Questions Answered:

  • How does treatment differ, if at all, between biochemically recurrent and non-metastatic castrate resistant prostate cancer patients? What secondary hormone manipulations, if any, are employed?
  • What is the most preferred sequencing of treatment among the asymptomatic, and symptomatic metastatic castrate resistant prostate cancer patients?
  • What are the main key drivers and obstacles to prescribing of the current therapies in the treatment of metastatic castrate-resistant prostate cancer?
  • How does treatment duration of key therapies (e.g., LHRH agonists, Zytiga, and Xtandi) differ by clinical setting (e.g., newly diagnosed patients vs. biochemical recurrent vs. castrate-resistant) according to surveyed physicians?

Markets covered: France, Germany, Italy, Spain, United Kingdom.

Primary research: Survey of 250 European oncologists and urologists (~50 in each of the EU5 countries) fielded in February 2017.

Key companies: Johnson & Johnson, Astellas Pharma (Medivation), Bayer Healthcare, Sanofi-Aventis

Key drugs: Xtandi, Xofigo, Jevtana, Zytiga

Table of contents

  • Prostate Cancer - Current Treatment - Detailed, Expanded Analysis (EU)
    • Key Updates
      • December 2017
    • Introduction to Current Treatment for Prostate Cancer
      • Key Findings
      • Summary Figures
        • Pharmacological Treatment Rates for Newly Diagnosed Prostate Cancer: Oncologists
        • Pharmacological Treatment Rates for Newly Diagnosed Prostate Cancer: Urologists
        • Pharmacological Treatment Rates for Biochemically Recurrent and Nonmetastatic Castrate-Resistant Prostate Cancer: Oncologists
        • Pharmacological Treatment Rates for Biochemically Recurrent and Nonmetastatic Castrate-Resistant Prostate Cancer: Urologists
        • Patient Share of Drug Therapies for Metastatic Castrate-Resistant Prostate Cancer: Oncologists
        • Patient Share of Drug Therapies for Metastatic Castrate-Resistant Prostate Cancer: Urologists
      • Introduction to Current Treatment and Medical Practice for Prostate Cancer
      • Drugs Included in This Study of Current Treatment of Prostate Cancer
    • Physician Prescribing Practices
      • Key Findings
      • Patient Characteristics
        • PSA Doubling Time and Gleason Score Are the Most Preferred for Risk Assessment of Biochemical Recurrence
        • Risk Assessment Techniques for Prostate Cancer Patients at Risk of Biochemical Recurrence
        • Symptom Status Among Patients with Metastatic Castrate-Resistant Prostate Cancer
        • Rates of Rising PSA in Symptomatic and Minimally Symptomatic Metastatic Castrate-Resistant Prostate Cancer
        • Evidence of Distant Metastases Among Castrate-Resistant Patients in the First-and Second-Line Treatment Settings
        • ECOG Scores of Metastatic Castrate-Resistant Patients Who Present with Metastatic Disease vs. Those Who Are Previously Treated
      • Physician Treatment Practices for Newly Diagnosed Patients
        • Treatment Decision Varies Among Urologists and Oncologists Depending on the Advancement of Disease Stage
        • Antineoplastic Drug Therapy Is More Commonly Prescribed for Newly Diagnosed Metastatic Disease than for Earlier-Stage Disease
        • Pharmacological Treatment Rates for Newly Diagnosed Prostate Cancer: Oncologists
        • Pharmacological Treatment Rates for Newly Diagnosed Prostate Cancer: Urologists
        • Surveyed U.K. Urologists and Oncologists Mostly Prescribe LHRH Agonists to Newly Diagnosed Patients After Brief Antiandrogen Treatment
        • Patient Share of Drug Therapies for Newly Diagnosed Prostate Cancer: Oncologists
        • Patient Share of Drug Therapies for Newly Diagnosed Prostate Cancer: Urologists
        • Surveyed Urologists Report Significantly Longer Treatment of Newly Diagnosed Localized and Locally Advanced Prostate Cancer Compared with Oncologists
        • Treatment Duration of LHRH Agonists in Localized and Locally Advanced Prostate Cancer
        • Factors Influencing the Decision Whether to Initiate Treatment in Biochemically Recurrent Patients: Urologists
        • Treatment Initiation Decision Factors in Biochemically Recurrent Patients
        • Biochemical Progression in Localized and Locally Advanced Prostate Cancer
      • Physician Treatment Practices for Biochemically Recurrent and Castrate-Resistant Patients
        • Drug-treatment Rates Higher in mCRPC Patients than the Biochemically Recurrent and Nonmetastatic Prostate Cancer
        • Antineoplastic Treatment Is Most Commonly Preferred in Earlier-Line Biochemically Recurrent and Metastatic Castrate-Resistant Prostate Cancer
        • Pharmacological Treatment Rates for Metastatic Castrate-Resistant Prostate Cancer
        • Pharmacological Treatment Rates for Metastatic Castrate-Resistant Prostate Cancer: Oncologists
        • Pharmacological Treatment Rates for Metastatic Castrate-Resistant Prostate Cancer: Urologists
        • Treatment Is Highly Variable for Biochemically Recurrent, Nonmetastatic, and Metastatic Castrate-Resistant Prostate Cancer
        • Patient Share of Drug Therapies for Biochemically Recurrent and Nonmetastatic Castrate-Resistant Prostate Cancer: Oncologists
        • Patient Share of Drug Therapies for Biochemically Recurrent and Nonmetastatic Castrate-Resistant Prostate Cancer: Urologists
        • Distribution of Antiandrogen Therapy for Biochemically Recurrent and Nonmetastatic Castrate-Resistant Prostate Cancer: Oncologists
        • Distribution of Antiandrogen Therapy for Biochemically Recurrent and Nonmetastatic Castrate-Resistant Prostate Cancer: Urologists
        • Distribution of LHRH Therapy for Biochemically Recurrent and Nonmetastatic Castrate-Resistant Prostate Cancer: Oncologists
        • Distribution of LHRH Therapy for Biochemically Recurrent and Nonmetastatic Castrate-Resistant Prostate Cancer: Urologists
        • Nonmetastatic Castrate-Resistant Prostate Cancer Patients Receiving Secondary Hormone Therapy
        • Secondary Hormone Therapies in Nonmetastatic Castrate-Resistant Patients: Oncologists
        • Secondary Hormone Therapies in Nonmetastatic Castrate-Resistant Patients: Urologists
        • Patient Share of Drug Therapies for Metastatic Castrate-Resistant Prostate Cancer: Oncologists
        • Patient Share of Drug Therapies for Metastatic Castrate-Resistant Prostate Cancer: Urologists
        • Treatment Durations for Zytiga and Xtandi Exceed One Year for Biochemically Recurrent and Nonmetastatic Castrate-Resistant Prostate Cancer
        • Intermittent Hormonal Therapy Share in Prostate Cancer Patients
        • Most Common Intermittent Hormonal Treatment Schedules: Oncologists
        • Most Common Intermittent Hormonal Treatment Schedules: Urologists
        • Treatment Duration of Zytiga and Xtandi for First-Line Metastatic Castrate-Resistant Prostate Cancer
        • Compliance Rates Are Lower and Early Discontinuation Rates Are Higher with Jevtana than with Novel Hormonal Agents and Xofigo
        • Compliance Rates for Key Metastatic Castrate-Resistant Prostate Cancer Therapies
        • Early Discontinuation Rates of Key Metastatic Castrate-Resistant Prostate Cancer Therapies
        • Rate of Disease Progression and Mortality Increase with Line of Therapy in Metastatic Castrate-Resistant Prostate Cancer Patients
        • Disease Progression in Biochemically Recurrent and Nonmetastatic Castrate-Resistant Prostate Cancer
        • Disease Progression in Metastatic Castrate-Resistant Prostate Cancer
      • Sequencing of Treatment
        • Chemotherapy Is Used More Frequently Upfront for Symptomatic mCRPC and by Oncologists Rather than Urologists in All Lines Irrespective of Symptom Status
        • Most Frequent Sequence of Treatment for Metastatic Castrate-Resistant Prostate Cancer Patients Presenting with Asymptomatic or Minimally Symptomatic Disease
        • Most Frequent Sequence of Treatment for Metastatic Castrate-Resistant Prostate Cancer Patients Presenting with Symptomatic Disease
        • Physician Opinion on Sequencing of Therapies for Metastatic Castrate-Resistant Prostate Cancer
      • Recent and Anticipated Changes in Treatment Practices
        • Prescriptions of Xofigo Limited by Radionuclear Facilities' Availability and Capacity
        • Urologists' and Oncologists' Opinions on Key Market Issues in Metastatic Castrate-Resistant Prostate Cancer
    • Physician Insight on Medical Practice
      • Key Findings
      • Major Drivers of Brand Use/Treatment
        • Overall Efficacy and Convenient Administration Are the Most Influential Prescribing Factors Cited by Oncologists and Urologists, Respectively
        • Clinical Factors Influencing Prescribing of Jevtana for Metastatic Castrate-Resistant Prostate Cancer
        • Clinical Factors Influencing Prescribing of Xofigo for Metastatic Castrate-Resistant Prostate Cancer
        • Clinical Factors Influencing Prescribing of Xtandi for Metastatic Castrate-Resistant Prostate Cancer
        • Clinical Factors Influencing Prescribing of Zytiga for Metastatic Castrate-Resistant Prostate Cancer
        • Clinical Factors Influencing First-Line-Prescribing of Zytiga over Xtandi Among Prescribers in Metastatic Castrate-Resistant Prostate Cancer
        • Clinical Factors Influencing First-Line Prescribing of Xtandi over Zytiga Among Prescribers in Metastatic Castrate-Resistant Prostate Cancer
        • Clinical Factors Influencing First-Line Prescribing of Xofigo Prescriptions in Metastatic Castrate-Resistant Prostate Cancer Patients with Symptomatic Bone Metastases
      • Major Obstacles to Brand Use/Treatment
        • Cost Is a Key Constraining Factor on Prescribing Novel Therapies for mCRPC
        • Obstacles Restricting Prescribing of Xtandi for Metastatic Castrate-Resistant Prostate Cancer
        • Obstacles Restricting Prescribing of Zytiga for Metastatic Castrate-Resistant Prostate Cancer
        • Obstacles Restricting Prescribing of Xofigo for Metastatic Castrate-Resistant Prostate Cancer
      • Insight on Treatment Failure/Brand Issues
        • Treatment-Related Adverse Events and Disease Progression Are the Main Reasons Why Patients Do Not Receive the Intended Duration of Treatment
        • Rationale for Failure to Receive the Intended Duration of Treatment: Jevtana
        • Rationale for Failure to Receive the Intended Duration of Treatment: Xofigo
        • Rationale for Failure to Receive the Intended Duration of Treatment: Xtandi
        • Rationale for Failure to Receive the Intended Duration of Treatment: Zytiga
    • Methodology
      • Primary Market Research Methodology
      • Primary Specialty of Surveyed Physicians
      • Oncologists' Years in Practice Postresidency, by Country
      • Urologists' Years in Practice Postresidency, by Country
      • Years in Practice Postresidency, by Specialty
      • Average Number of Prostate Cancer Patients Treated per Month by Oncologists, by Country
      • Average Number of Prostate Cancer Patients Treated per Month by Urologists, by Country
      • Average Number of Prostate Cancer Patients Treated per Month by Oncologists and Urologists
      • Therapies Prescribed by Oncologists for Prostate Cancer, by Country
      • Therapies Prescribed by Urologists for Prostate Cancer, by Country
      • Therapies Prescribed for Prostate Cancer: Oncologists vs. Urologists
      • Location of Surveyed Physicians' Practice, by Country
      • Practice Setting of Surveyed Oncologists, by Country
      • Practice Setting of Surveyed Urologists, by Country
      • Practice Setting of Surveyed Urologists and Oncologists
      • Professional Time That Surveyed Oncologists Spend in Clinical Practice, by Country
      • Professional Time That Surveyed Urologists Spend in Clinical Practice, by Country
      • Professional Time Spent in Clinical Practice: Oncologists vs. Urologists
    • Appendix
      • Primary Market Research
        • Risk Assessment Techniques for Prostate Cancer Patients at Risk of Biochemical Recurrence: Urologists
        • Risk Assessment Techniques for Prostate Cancer Patients at Risk of Biochemical Recurrence: Oncologists
        • Symptom Status Among Metastatic Castrate-Resistant Prostate Cancer Population: Oncologists
        • Symptom Status Among Metastatic Castrate-Resistant Prostate Cancer Population: Urologists
        • Rates of Rising PSA in Symptomatic and Minimally Symptomatic Metastatic Castrate-Resistant Patients: Oncologists
        • Rates of Rising PSA in Symptomatic and Minimally Symptomatic Metastatic Castrate-Resistant Patients: Urologists
        • Evidence of Distant Metastases Among Metastatic Castrate-Resistant Patients in the First- and Second-Line Treatment Settings
        • ECOG Scores of Metastatic Castrate-Resistant Patients Who Present with Metastatic Disease vs. Those Who Are Previously Treated
        • Pharmacological Treatment Rates for Newly Diagnosed Prostate Cancer
        • Pharmacological Treatment Rates for Biochemically Recurrent and Nonmetastatic Castrate-Resistant Prostate Cancer
        • Patient Share of Drug Therapies for Newly Diagnosed Prostate Cancer
        • Treatment Duration of LHRH Agonists for Localized and Locally Advanced Prostate Cancer
        • Treatment Initiation Decision Factors in Biochemically Recurrent Patients: Urologists
        • Treatment Initiation Decision Factors in Biochemically Recurrent Patients: Oncologists
        • Biochemical Progression in Localized or Locally Advanced Prostate Cancer
        • Pharmacological Treatment Rates for Biochemically Recurrent and Nonmetastatic Castrate-Resistant Prostate Cancer: Oncologists
        • Pharmacological Treatment Rates for Biochemically Recurrent and Nonmetastatic Castrate-Resistant Prostate Cancer: Urologists
        • Distribution of Antiandrogen Therapy for Biochemically Recurrent and Nonmetastatic Castrate-Resistant Prostate Cancer
        • Distribution of Antiandrogen Therapy for Biochemically Recurrent and Nonmetastatic Castrate-Resistant Prostate Cancer
        • Distribution of LHRH Therapy for Biochemically Recurrent and Nonmetastatic Castrate-Resistant Prostate Cancer
        • Nonmetastatic Castrate-Resistant Prostate Cancer Patients Receiving Secondary Hormone Therapy: Urologists
        • Nonmetastatic Castrate-Resistant Prostate Cancer Patients Receiving Secondary Hormone Therapy: Oncologists
        • Secondary Hormone Therapies in Nonmetastatic Castrate-Resistant Patients
        • Nonmetastatic Castrate-Resistant Prostate Cancer Patients Receiving Secondary Hormone Therapy
        • Patient Share of Drug Therapies for Metastatic Castrate-Resistant Prostate Cancer
        • Intermittent Hormonal Therapy in Prostate Cancer Patients: Oncologists
        • Intermittent Hormonal Therapy in Prostate Cancer Patients: Urologists
        • Most Common Intermittent Hormonal Treatment Schedules
        • Intended and Average Treatment Duration for Zytiga and Xtandi
        • Treatment Duration of Zytiga and Xtandi in Biochemically Recurrent and Nonmetastatic Castrate-Resistant Prostate Cancer
        • Treatment Duration of Zytiga and Xtandi in First-Line Metastatic Castrate-Resistant Prostate Cancer
        • Compliance Rates for Key Therapies for Metastatic Castrate-Resistant Prostate Cancer
        • Early Discontinuation Rates of Key Therapies for Metastatic Castrate-Resistant Prostate Cancer
        • Disease Progression in Biochemically Recurrent and Nonmetastatic Castrate-Resistant Prostate Cancer
        • Disease Progression in Metastatic Castrate-Resistant Prostate Cancer
        • Oncologists' Opinions on Key Market Issues in Metastatic Castrate-Resistant Prostate Cancer
        • Urologists' Opinions on Key Market Issues in Metastatic Castrate-Resistant Prostate Cancer
        • Oncologists' Opinion on Sequencing of Therapies for Metastatic Castrate-Resistant Prostate Cancer
        • Urologists' Opinion on Sequencing of Therapies for Metastatic Castrate-Resistant Prostate Cancer
        • Obstacles Restricting Prescribing of Xtandi for Metastatic Castrate-Resistant Prostate Cancer
        • Obstacles Restricting Prescribing of Zytiga for Metastatic Castrate-Resistant Prostate Cancer
        • Obstacles Restricting Prescribing of Xofigo for Metastatic Castrate-Resistant Prostate Cancer
      • Sequencing of Treatment
        • Most Frequent Sequence of Treatment for Metastatic Castrate-Resistant Prostate Cancer Patients Presenting with Asymptomatic or Minimally Symptomatic Disease
        • Most Frequent Sequence of Treatment for Metastatic Castrate-Resistant Prostate Cancer Patients Presenting with Asymptomatic or Minimally Symptomatic Disease: Oncologists
        • Most Frequent Sequence of Treatment for Metastatic Castrate-Resistant Prostate Cancer Patients Presenting with Asymptomatic or Minimally Symptomatic Disease: Urologists
        • Most Frequent Sequence of Treatment for Metastatic Castrate-Resistant Prostate Cancer Patients Presenting with Symptomatic Disease
        • Most Frequent Sequence of Treatment for Metastatic Castrate-Resistant Prostate Cancer Patients Presenting with Symptomatic Disease: Oncologists
        • Most Frequent Sequence of Treatment for Metastatic Castrate-Resistant Prostate Cancer Patients Presenting with Symptomatic Disease: Urologists
    • Bibliography
    • Key Abbreviations

Author(s): Swati Tyagi, M.Sc, MBA; Rachel Webster

Swati Tyagi, is a Senior Business Insight Analyst in the oncology team at the Decision Resources Group.

She comes with 8 years of work experience from the life sciences market research industry. She has in-depth expertise in competitive intelligence, secondary and primary research, and strategic projects across multiple oncology indications. Prior to joining the company, she was a delivery manager in a market research organization, where she was handling a major client engagement account and a dedicated team of senior and business analysts working for the specialty medicine brands of the client. She holds an M.Sc in biotechnology and MBA from Amity University, India.

Rachel Webster M.Sc., D.Phil., is a senior director in the oncology and biosimilars team at Decision Resources Group, where she manages a team of analysts in producing syndicated primary and secondary market research reports on a wide range of oncology indications. She also provides sales and client support for all oncology products.

Previously, Dr. Webster was a senior analyst in the oncology group at Decision Resources. Dr. Webster has extensive experience in market forecasting with detailed expertise in cancer immunotherapies, prostate cancer, gastric cancer, and malignant melanoma. Dr Webster is also experienced in conducting primary research with physicians and payers in a wide range of oncology indications across the major pharmaceutical markets. Prior to joining Decision Resources Group, Dr. Webster was a research scientist at Immunocore in the target validation group, where her research focused on identifying target antigens expressed in cancers and autoimmune diseases using a proprietary T-cell receptor (TCR) technology platform, molecular biology and phage display techniques. Dr. Webster obtained her D.Phil., in biochemistry, M.Sc. and M.A (Hons) in biological sciences, from the University of Oxford.


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