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Background <p>Androgen deprivation therapy (ADT) has been pivotal in advanced prostate cancer (PCa) for decades. The introduction of androgen-receptor pathway inhibitors (ARPIs) has transformed treatment paradigms. However, their real-world adoption over time has not been comprehensively characterised. We examined prescribing trends for androgen-directed therapies in Australia over a 29-year period.</p> Methods <p>A retrospective population-based analysis of Pharmaceutical Benefits Scheme (PBS) dispensing data (1996–2024) was performed. PBS-listed anti-androgen therapies—luteinising hormone-releasing hormone (LHRH) agonists (goserelin, leuprorelin, triptorelin), combined androgen blockage (CAB) (LHRH + bicalutamide), ARPIs (enzalutamide, apalutamide, darolutamide, abiraterone)—were included. Annual prescription counts were standardised per 100,000 men. Outcomes included temporal trends, proportional contribution of each drug class, and the effect of ARPI introduction using interrupted time-series (ITS) analysis.</p> Results <p>Anti-androgen prescriptions rose from 146 to 228,707 between 1996 and 2024, respectively. LHRH monotherapy accounted for &gt; 94% of prescriptions prior to ARPI approval, declining to 51.61% in 2024 despite continued absolute growth (+ 65.16 prescriptions/100,000/year, <i>p &lt; </i>0.0001). ARPIs expanded following PBS listing, increasing from 2.44% in 2013 to 47.28% in 2024 (+ 131.9 prescriptions/100,000/year, <i>p &lt; </i>0.0001). ITS modelling demonstrated a significant immediate level increase of + 9.85 percentage points (<i>p &lt; </i>0.0001) and sustained a post-intervention slope increase of + 3.04 percentage points per year (<i>p &lt; </i>0.0001) following ARPI introduction, closely mirroring observed proportional and absolute growth 3.44–47.28% between 2013 and 2024, respectively.</p> Conclusion <p>Australia has transitioned from predominately LHRH-based therapy to widespread use of ARPIs. Health-system structures enabling timely clinical access appears pivotal to the rapid and equitable diffusion of high-value androgen-targeted therapies.</p>

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Long-term trends in androgen-directed therapy in advanced prostate cancer: a 29-year national analysis

  • 期刊论文

  • 发表日期：

    2026年1月10日

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  • Kieran Sandhu,
  • Cynthia Wells,
  • Matilda M. H. Newton,
  • Declan G. Murphy,
  • Nathan Lawrentschuk,
  • Marlon L. Perera

摘要

Background

Androgen deprivation therapy (ADT) has been pivotal in advanced prostate cancer (PCa) for decades. The introduction of androgen-receptor pathway inhibitors (ARPIs) has transformed treatment paradigms. However, their real-world adoption over time has not been comprehensively characterised. We examined prescribing trends for androgen-directed therapies in Australia over a 29-year period.

Methods

A retrospective population-based analysis of Pharmaceutical Benefits Scheme (PBS) dispensing data (1996–2024) was performed. PBS-listed anti-androgen therapies—luteinising hormone-releasing hormone (LHRH) agonists (goserelin, leuprorelin, triptorelin), combined androgen blockage (CAB) (LHRH + bicalutamide), ARPIs (enzalutamide, apalutamide, darolutamide, abiraterone)—were included. Annual prescription counts were standardised per 100,000 men. Outcomes included temporal trends, proportional contribution of each drug class, and the effect of ARPI introduction using interrupted time-series (ITS) analysis.

Results

Anti-androgen prescriptions rose from 146 to 228,707 between 1996 and 2024, respectively. LHRH monotherapy accounted for > 94% of prescriptions prior to ARPI approval, declining to 51.61% in 2024 despite continued absolute growth (+ 65.16 prescriptions/100,000/year, p < 0.0001). ARPIs expanded following PBS listing, increasing from 2.44% in 2013 to 47.28% in 2024 (+ 131.9 prescriptions/100,000/year, p < 0.0001). ITS modelling demonstrated a significant immediate level increase of + 9.85 percentage points (p < 0.0001) and sustained a post-intervention slope increase of + 3.04 percentage points per year (p < 0.0001) following ARPI introduction, closely mirroring observed proportional and absolute growth 3.44–47.28% between 2013 and 2024, respectively.

Conclusion

Australia has transitioned from predominately LHRH-based therapy to widespread use of ARPIs. Health-system structures enabling timely clinical access appears pivotal to the rapid and equitable diffusion of high-value androgen-targeted therapies.