Recent approvals of second-generation androgen receptor inhibitors (SGARIs) have changed the\ntreatment landscape for non-metastatic castration-resistant prostate cancer (nmCRPC). These SGARIs have similar\nefficacy but differ in safety profiles. We used a discrete choice experiment to explore how United States physicians\nmake treatment decisions between adverse events (AEs) and survival gains in nmCRPC, a largely asymptomatic\ndisease.\nMethods: Treating physicians (n = 149) participated in an online survey that included 14 treatment choice\nquestions, each comparing 2 hypothetical treatment profiles, which varied in terms of 5 safety and 2 efficacy\nattributes. We described safety attributes (fatigue, skin rash, cognitive problems, falls, and fractures) in terms of\nseverity and frequency, and efficacy attributes (overall survival [OS] and time to pain progression) in terms of\nduration of effect. We used a random parameters logit model to estimate preference weights and importance\nscores for each attribute. We also estimated the amount of survival gain physicians were willing to trade for a\nreduction in specific AEs between treatment options.\nResults: Physicians placed more importance on survival than on time to pain progression, and viewed a reduction\nin cognitive problems from severe to none, a reduction in risk of a serious fracture from 8% to none, and a\nreduction in fatigue from severe to none as the most important safety attributes. Physicians were willing to forego\n9.1 and 6.6 months of OS, respectively, to reduce cognitive problems and fatigue from severe to mild-to-moderate.\nTo reduce the risk of a serious fracture from 8 to 5% and 5% to none, physicians were willing to trade 3.9 and 5.3\nmonths of OS, respectively.\nConclusions: Physicians were willing to trade substantial amounts of survival to avoid AEs between hypothetical\ntreatments. These results emphasize the importance of carefully balancing therapiesâ?? benefits and risks to ultimately\noptimize the overall quality of nmCRPC patientsâ?? survival. Nonetheless, it is noted that the results from the study\nsample of 149 physicans may not be representative of the viewpoints of all nmCRPC-treating physicians.
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