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Prostate Cancer Insight - Profiting From Changing Treatment Patterns
Datamonitor, Nov 2003, Pages: 523
Casodex 150mg withdrawn for the treatment of localized disease 3
Chapter 1 EXECUTIVE SUMMARY 4
Prostate Cancer Insight: methodology 5
Prostate Cancer Insight: key conclusions 6
The widespread introduction of PSA screening in Europe will occur over the next 10 years, leading to a US-style stage migration. Companies with marketed or developmental prostate cancer products must target the larger localized and recurrent disease populations that will result 7
Traditionally, total androgen blockade (TAB) has been shunned by urologists. However, new literature reviews are now challenging physicians’ preconceptions and changing prescribing habits in favor of TAB, producing a niche market for low toxicity anti-androgens 11
The average age of Japanese patients is higher than in Western markets. This means that aggressive therapy is often contraindicated. Consequently, more patients receive drug-based therapy, producing a deceptively large drug market that should be targeted by manufacturers 15
Intermittent hormonal therapy (IHT) may provide an improvement in efficacy and side effects over continuous hormonal therapy. Manufacturers of hormonal products must consider how they may capitalize on the uptake of IHT if current trials show an advantage to the new treatment strategy 16
Taxotere is becoming the treatment of choice for hormone refractory prostate cancer (HRPC). Companies with products in development for HRPC should assess their products in combination with the taxane 21
Summary of points: the prostate cancer market to 2015 23
Chapter 2 INTRODUCTION 32
The prostate 33
Prostate cancer 34
Histology 34
Etiology 35
Epidemiology 37
Incidence forecasts 39
Point prevelence forecasts 40
Chapter 3 SCREENING, DIAGNOSIS AND STAGING 41
Screening 41
Prostate cancer screening 41
Summary and comments 47
Diagnostic methods 48
Staging 49
Clincal staging 49
Gleason grade 52
Physician data 54
Screening 54
The effect of screening on presentation pattern 58
Diagnosis and staging tests 61
Chapter 4 TREATMENT OF LOCALIZED DISEASE 66
New and old treatment options for localized disease 66
Watchful Waiting 67
Surgery for localized disease 69
Radical Prostatectomy 69
Cryotherapy 73
Radiotherapy for localized disease 74
Brachytherapy 75
External beam radiotherapy 84
How effective are 3DCRT and IMRT? 85
Toxicity of 3DCRT and IMRT 87
Adjuvant hormonal therapy 89
Hormonal therapy 90
Summary 98
Physician data 99
Watchful waiting 99
Surgery 102
Radiotherapy 111
Drug Therapy 127
Disease outcome for localized prostate cancer 146
Chapter 5 TREATMENT OF LOCALLY ADVANCED DISEASE 150
Treament options for locally advanced prostate cancer 150
Regional variation in treatment patterns 151
Surgery 151
Hormonal therapy alone 153
Radiotherapy 159
Summary 163
Physician data 164
Choosing no treatment 164
Surgery 166
Radiotherapy 171
Drug therapy 178
Disease outcome for locally advanced prostate cancer 185
Chapter 6 TREATMENT OF METASTATIC DISEASE 189
Treatment options for metastatic prostate cancer 189
Surgery 189
Radiotherapy 192
Drug therapy 194
Summary 205
Lymph metastases 205
Distant metastases 206
Physician data 207
Refusing treatment 207
Surgery 209
Radiotherapy 216
Drug therapy 223
Chapter 7 TREATMENT OF HRPC 241
Definition of HRPC 241
Development of HRPC 241
Progression to HRPC 242
Prognosis of HRPC 243
Approved agents for HRPC 245
Estramustine 245
Mitoxantrone 249
Key investigational agents for HRPC 251
Taxol (paclitaxel) 251
Taxotere (docetaxel) 252
Taxol versus Taxotere 254
Navelbine (vinorelbine) 255
Ketaconazole 257
Estrogens 258
Physician data 260
Drug therapy for HRPC patients 260
Drug regimens for HRPC 268
The use of cytotoxics in the last five years 280
Key investigational drugs for HRPC 283
Atrasentan (ABT-627) 284
Thalomid (thalidomide) 287
Iressa (gefitinib) 289
YM598 291
Glivec (imatinib) 292
Conclusions 293
Chapter 8 SIDE EFFECTS AND SUPPORTIVE CARE 294
Loss of bone integrity and bone pain 294
Sexual function-related side effects including hot flashes 294
Loss of libido 294
Impotence/erectile dysfunction 298
Hot flashes 303
Discontinuation of treatment due to sex-related side effects 309
Incontinence and diarrhea 310
Urinary incontinence 310
Bowel incontinence 314
Diarrhea 316
Discontinuation of treatment due to the side effects 318
Breast-related side effects 319
Gynecomastia 319
Breast pain (and tenderness) 323
Discontinuation of treatment due to gynecomastia and breast pain 326
Psychological side effects 327
Chapter 9 TREATMENT STRATEGY 328
Treatment of poor prognosis patients 328
Physician data 329
The management of testosterone flare 341
Physician data 350
Intermittent hormonal therapy 356
Physician data 364
Bisphosphonates and prostate cancer 371
Physician data 386
Chapter 10 COMMERCIAL ANALYSIS 401
Influence of treatment guidelines 401
Non-clinical factors influencing prescribing 404
Clinical investigation and research 408
Sales representative market coverage 411
Chapter 11 SUPPORTING DATA 414
Duration of first-line drug therapy and progression factors 414
Second-line drug therapy 419
Third-line drug therapy 423
Chapter 12 APPENDIX A 427
Contributing experts 427
List of tables 428
List of figures 437
Bibliography 443
Physician research methodology 475
Introduction 475
Our research partners 477
Research objectives 477
Questionnaire development 480
Research methodology 481
Data processing 483
Quality control 484
Opinion Leader research 485
Prostate Cancer Insight Questionnaire 487
OncoVision 517
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