Prostate cancer (PC) treatment is rapidly evolving with new modalities providing more personalized, effective, and increasingly costly options. Several new treatments for non-metastatic castrate-resistant prostate cancer (NM-CRPC), including immunotherapies, antiandrogens,  bone-targeted agents, and androgen-receptor targeted agents, have been tested or are currently being tested in clinical trials, all aiming to prolong metastasis-free survival. Although current Canadian and US guidelines do not recommend systemic chemotherapy or immunotherapy for NM-CRPC, patients are encouraged to participate in clinical trials.

Information regarding the current incidence, prevalence and cost of treatment of NM-CRPC and more advanced stages is currently lacking in Canada. This information is highly important for Canadian policymakers facing reimbursement decisions for new drug and non-drug health technologies. Therefore, more up-to-date and robust epidemiologic and economic data concerning NM-CRPC and advanced PC are needed to guide future research and policy decision-making

Study Design & Objectives

This is a three–project retrospective study to obtain comprehensive data on the epidemiology and health care costs of males with NM-CRPC using data from cancer registries, administrative health care databases, and PC clinics in two Canadian provinces, Ontario and Quebec. The study will also identify the pathways leading to NM-CRPC and estimate transition probabilities from previous health states and to subsequent ones. Our specific objectives are to:

  • Obtain current prevalence, incidence and survival probability estimates of PC stratified by age, year of diagnosis, and stage of diagnosis (Project 1);
  • Identify pathways leading to and factors associated with developing NM-CRPC using information from patient medical records at PC clinics (Project 2);
  • Estimate annual incidence and prevalence of NM-CRPC, using administrative data (Project 3);
  • Estimate stratified probability of developing NM-CRPC and transition probabilities that characterize the prognosis from NM-CRPC to metastasis and end-of-life (Projects 2 & 3);
  • Estimate health care resource use and costs of PC recurrence from NM-CRPC to metastasis and death (Project 3).


Currently, projects 1 and 2 are underway.

Research Team

Murray Krahn, MD MSc FRCPC (Co-PI)
Antonio Finelli, MD MSc FRCPC (Co-PI)
Valeria Rac, MD, PhD (Investigator)
Lusine Abrahamyan, MD, PhD (Investigator)
William Wong, PhD (Investigator)
Alice Dragomir, PhD (Investigator)
Amen Aprikian, MD (Investigator)
Stuart Peacock, PhD (Investigator)
Shabbir Alibhai, MD MSc, FRCPC (Investigator)
Karen Bremner, BSc (Study Coordinator)
Steven Carcone, MSc (Research Associate)
Lisa Masucci, MSc PhD(c) (Collaborator)
Nicholas Mitsakakis, MSc, PhD (Biostatistician)


Prostate Cancer Canada