Key treatment options and costs associated Dominik Berthold, European School of Oncology (ESO)

1. Key Treatment Options and Costs
associated with Prostate Cancer
Dr Dominik Berthold
Medical oncology, Lausanne Switzerland &
European School of Oncology, Milan Italy

2. Prostate cancer: Same name but different diseases
Incidental prostate cancer at
autopsy: > 50%
11% cancer deaths of all male
cancers are PC related

3. Management options for localized PC
Watchful
waiting
Active
surveillance
Focal therapy
• HIFU
• Cryotherapy
Surgery
• open
• robotic assisted
Radiation therapy
• Standard RT
• Hypo-fractionation
• Brachytherapy
• ± Hormones
Aim: cure or control at minimal treatment burden

4. Treatment options for metastatic PC
Castration
• surgical
• medical
Chemotherapy
• docetaxel
• cabazitaxel
Hormonal Agents
• Abiraterone
• Enzalutamide
Bone targeted agents
• Radium 223
• Zoledronic acid
• Denosumab
Immune therapy
• Sipuleucel T (US
only)
Aim: maximizing survival and quality of life

5. Evolution of treatment options for metastatic PC
Logo of speaker’s organisation
Enzalutamide
Abiraterone Abiraterone
Denosumab Denosumab
Radium 223 Radium 223
Cabazitaxel Cabazitaxel Cabazitaxel
Zoledronic
acid
SipulocelT SipulocelT SipulocelT
Mitoxantrone Docetaxel Docetaxel Docetaxel Docetaxel
Castration Medical
castration
Medical
castration
Medical
castration
Medical
castration
Medical
castration
Medical
castration
1941 1980 1996 2004 2010 2011 2012 2017
Rightdrug-righttime-rightpatient

6. RESERACH
Ongoing interventional phase III studies for prostate cancer: 70
Metastatic prostate cancer
• 25 Phase III RCT currently recruiting patients
• > 15.000 men to be recruited
• Uncountable phase I and II studies in immunotherapy and other
approaches potentially practice-changing for PC
Clinicaltrials.gov 22.9.2017

7. COSTS
Costs for cancer treatment
• Drugs
• Outpatient care
• Inpatient care
• Productivity loss
• Primary care
• Emergency care
Costs change rapidly, vary from nation to nation, are
difficult to calculate

8. Costs local treatment
$4075 to $6296 open surgery
$5058 to $11 806 robotic surgery
Treatment costs of prostate cancer in the first year after diagnosis for France, Germany,
Italy, Spain and the UK
BJU International, 7 JUL 2009
EUROPEAN UROLOGY 65 (2014) 316–324
Costs Surgery

9. Costs
Lancet Oncology, November 2013
Health-care costs prostate cancers per person in European Union countries in 2009

10. COSTS
Drug Price month/ cycle Typical use Total EURO
Medical castration 92 4 years 4416
Taxotere 360 6 cycles 2160
Jevatana 3800 6 cycles 22800
Zytiga 3150 6 months 18900
Xtendi 3150 6 months 18900
Xgeva 300 3 years 10800
Xofigo 5000 6 months 30000
Liste de prix et base de remboursement, Belgium 2017

11. age
62
age
70
age
79
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2016 2017
Surgery
5000,-
Relaps:
Radiotherapy
5000,- Medical
Castration
11000,-
Docetaxel
Cabazitaxel
Radium 223
Abiraterone
Enzalutamide
Docetaxel
-------Denosumab---------
Palliative
RT
240.000,- for drugs and
supportive care last 4 years of life
The total cost of this man
with PC was close to
300.000,- over 18 years.
Case Report

12. From: ESMO European Consortium Study on the availability, out-of-pocket costs and accessibility of antineoplastic
medicines in Europe
Ann Oncol. 2016;27(8):1423-1443. doi:10.1093/annonc/mdw213
Castrate-resistant prostate cancer: formulary availability and out-of-
pocket costs.

13. Conclusions
• The treatment options for prostate cancer are expanding
rapidly.
• Intensive research will further widen the spectrum of
therapeutic options and potentially costs
• Health Technology Assessments should be performed on all
new technologies in order to provide the base for effective
and efficient allocation of resources in prostate cancer
services.