Clinical characterization and treatment patterns in patients with metastatic hormone-sensitive prostate cancer at three third-level centers of the Mexican Institute of Social Security: A retrospective cohort study.
Authors: Rivera Samuel , Martinez-Valdez Libny , Cuellar Mendoza Miguel Enrique , Medrano Sanchez Javier , Sandoval Mendez Angelica Carolina , Oropeza Gretel , Reyes Garcia Ivan Alejandro , Velasco Ramon , Gutiérrez De la Torre Saúl , Acevedo-Ibarra Jessica Noemi , Ruiz Barbara , Rivas Isabella , Zapata Tarres Marta 
Published: February 2025

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Background:
In Latin America, prostate cancer (PC) is the most common cancer among men. Despite efforts in select institutions in Mexico to register and organize data on patients (pts) with PC, epidemiological data are scarce. This study described the demographic, clinical, and treatment-related characteristics of pts with metastatic hormone-sensitive PC (mHSPC) in reference centers for the Mexican Institute of Social Security (IMSS).
Methods:
This retrospective, observational, cohort study examined the health records of adult (≥18 years) pts newly diagnosed with mHSPC between January 1, 2017, and June 30, 2023. The pts were treated at one of the three tertiary hospitals of the IMSS and received ≥1 follow-up consultation after the date of mHSPC diagnosis. Criteria for mHSPC diagnosis: ICD-10 code C61 or D40; inclusion of “prostate cancer,” “adenocarcinoma of the prostate,” or “malignant tumor of the prostate” in pt charts; radiologic confirmation and stage IV/metastatic disease diagnosis by an oncologist/urologist; hormone sensitivity with/without prior androgen-deprivation therapy (ADT) (having stopped ADT ≥12 months before confirmation of metastatic disease); or clinically equivalent diagnosis. Pts were stratified by the tumor, node, metastasis (TNM) staging system of PC (8
th
ed). Only metastatic disease (i.e., any T or N and M1) was considered at baseline.
Results:
In total, 454 pts’ charts were reviewed:246 did not have metastatic disease, 42 had metastatic castration-resistant prostate cancer, and 166 (37%) had mHSPC. Of these 166 pts (median [SD] age, 69.5 [8.3] years),71% (n = 117)had Gleason score ≥8, 20% (n = 33) had confirmed nodal spread (N1), and 65% (n = 108) had confirmed metastasis (M1) at the time of diagnosis. Pts received the following treatments (n, %): gonadotropin-releasing hormone (GnRH) agonist (144, 87%), GnRH antagonist (5, 3%), orchiectomy (3, 2%), androgen receptor pathway inhibitor (32, 19%), and chemotherapy (31, 19%). In 35 pts, ADT was discontinued due to biochemical progression (20%), radiological progression (6%), radiological and biochemical progression (3%), or progression due to an unspecified cause (9%). There were 10 adverse events (AEs): 4 pts had grade 3 AEs, 5 pts had grade 4 AEs, and 1 pt had an AE of unspecified grade.
Conclusions:
This study identified clinical characteristics of and treatment variations in pts with mHSPC at the IMSS. Treatment patterns differed despite consensus in clinical guidelines. These results may help drive critical analyses of clinical decision-making, inform optimal data collection practices, and support the strengthening of cancer registries in Mexico.