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Educational Need in Castration-Resistant Prostate Cancer

Top 3 ABNS competencies addressed by the educational content.

Due to the increase in treatment options for castration-resistant prostate cancer (CRPC) in recent years, some confusion exists over the optimal therapeutic approach. A number of factors must be considered in CRPC treatment, including patient health status, rate of disease progression and disease burden, presence of bone or visceral metastases, mechanism of action and tolerability of available agents, and prior lines of therapy and response.

Baseline data collected from i3 Health's continuing medical education/continuing nursing education (CME/CNE)-approved visiting faculty meeting series titled Challenges and Opportunities in Castration-Resistant Prostate Cancer revealed significant knowledge gaps surrounding the management and treatment of CRPC.

The activity, which was available online from November 29, 2018, to March 29, 2019, was completed by 181 participants, including 100 physicians, 11 physician assistants, 18 nurse practitioners, 15 registered nurses, 12 pharmacists, and 14 others. Participants had an average of 17 years in practice and saw an average of 11 patients with CRPC per month. According to the results of a pretest which participants completed before beginning the activity, knowledge at baseline was as follows:

  • 75.3% of participants were able to recognize that cabazitaxel/prednisone would not improve the overall survival of a patient with metastatic CRPC compared with docetaxel/prednisone
  • 18% of participants were able to recall the expected metastasis-free survival of a patient with non-metastatic CRPC receiving apalutamide/androgen deprivation therapy (ADT)
  • 77.1% of participants were able to determine the appropriate management of a patient with enzalutamide-induced grade 3 fatigue
  • 26% of participants were able to identify the adverse event that a patient receiving abiraterone/prednisone would likely experience
  • 77% of participants were able to recall that treatment should not be discontinued in a patient with metastatic CRPC with a rising (PSA) level who otherwise feels well and has no changes on imaging

Upon completion of the activity, participants answered the same questions to determine if their understanding of CRPC management and treatment had improved, yielding the following results:

  • 89% of participants were able to recognize that cabazitaxel/prednisone would not improve the overall survival of a patient with metastatic CRPC compared with docetaxel/prednisone
  • 69% of participants were able to recall the expected metastasis-free survival of a patient with non-metastatic CRPC receiving apalutamide/ADT
  • 92% of participants were able to determine the appropriate management of a patient with enzalutamide-induced grade 3 fatigue
  • 35.3% of participants were able to identify the adverse event that a patient receiving abiraterone/prednisone would likely experience
  • 75.2% of participants were able to recall that treatment should not be discontinued in a patient with metastatic CRPC with a rising PSA level who otherwise feels well and has no changes on imaging

While participant knowledge of the efficacy and safety of CRPC therapies increased, competence in adverse event management improved but remained suboptimal, and some confusion remained regarding post-treatment monitoring, signifying areas of educational need. Gaps between actual practice and evidence-based practice were also evident. Based on these data, further education is needed regarding CRPC risk assessment, efficacy and safety of novel therapies, implications of resistance in treatment selection, and treatment sequencing.

After completing the educational content, 83% of physicians and 74% of nurses reported that they felt more confident in treating their patients with CRPC, and 89% of physicians and 82% of nurses reported that they would use the presented material to improve the outcomes of their patients.

For More Information

i3 Health (2019). Challenges and opportunities in castration-resistant prostate cancer: activity outcomes summary report. Data on file. 


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