Real-world treatment patterns and survival outcomes in men with metastatic castration-resistant prostate cancer in Finland: a national, population-based cohort study.

Background: Metastatic castration-resistant prostate cancer (mCRPC) treatment is advancing yet Nordic, real-world evidence for its use is scarce. In this population-based cohort study, we describe characteristics of patients with mCRPC, and their treatment patterns and survival outcomes in Finland.
Methods: Incident patients with mCRPC diagnosed during 2013-2021 were identified from data lakes in two large and representative, Finnish hospital districts, and linked to data on drug purchases and causes of death from national registries.
Results: Of a total of 31,307 patients with prostate cancer, 2,475 progressed to mCRPC during 2013-2021. Those who received no life-prolonging treatment(s) (28% overall) were older with more comorbidities than treated patients. After 2018, the proportion of patients who received life-prolonging treatments increased from 61% to 80%. Of those who received treatment before androgen receptor pathway inhibitors (ARPIs) were reimbursed as first-line (1L) treatment for mCRPC in Finland, 68% received docetaxel, 19% abiraterone and 12% enzalutamide 1L; post-reimbursement, 4% received docetaxel, 24% abiraterone and 71% enzalutamide 1L. Median overall survival for treated patients with mCRPC was 28.3 (95% CI: 26.3-30.4) and 38.5 (95% CI: 32.7-42.1) months pre- and post-reimbursement of 1L-ARPIs, respectively.
Interpretation: The ARPI reimbursement status changes significantly influenced treatment patterns for mCRPC in Finland, favouring enzalutamide over docetaxel. This expanded the pool of men eligible for 1L treatment and improved overall survival by a median of 10 months. These findings highlight the importance of health policy decisions in shaping treatment strategies and patient outcomes in prostate cancer.