ASCO GU 2022: First Look at Patient Reported Outcomes from IRONMAN, the International Registry of Men with Advanced Prostate Cancer

( The 2022 GU ASCO Annual meeting included a prostate cancer session highlighting work from Dr. Emily Rencsok and colleagues presenting the first results from IRONMAN, an assessment of patient reported outcomes in an international registry of men with advanced prostate cancer. While population-based estimates of advanced prostate cancer survivors are lacking, an estimated 180,000 men in the US are living with metastatic prostate cancer. Their survivorship experience is distinct from localized patients as they suffer quality of life detriments both due to the severity of disease and its therapies. This study examined quality-of-life indicators among men in the IRONMAN global registry of advanced prostate cancer.

IRONMAN (International Registry of Men with Advanced Prostate Cancer) is a population-based prospective study of men with newly diagnosed advanced, metastatic hormone-sensitive (mHSPC) and castration-resistant prostate cancer (CRPC) enrolled from 16 countries. At GU ASCO 2022, Dr. Rencsok reported data from the first 1,865 men enrolled, 1,567 who completed a baseline Patient Reported Outcome Measure (PROM) in the US (N=581), Canada (N=245), Spain (N=166), UK (N=204), Australia (N=126), Switzerland (N=88), Sweden (N=70), Ireland (N=46), and Brazil (N=41). PROMs are collected at baseline and every three months using electronic (90%) or paper versions of validated questionnaires.

The cohort includes 1,128 men with mHSPC and 737 with CRPC. Based on self-report, 9% of men overall (18% in the US) are Black and 83% are white (78% in the US). Sleep problems were common among men at enrollment, with 59% of men reporting problems with insomnia, with the prevalence being similarly high among men with mHSPC or CRPC disease. Ten percent of men reported that pain substantially interfered with daily activities, and 24% reported pain had some effect. Physical functioning was high among both mHSPC (median 93.3, 80-100) and CRPC (median 86.7, 73.3-100) patients based on EORTC QLQ-30. Global health status was similar between the two groups (median 75, 58.3 - 83.3), and more than 25% of men reported some cognitive impairment at baseline. A summary of the PROMs stratified by mHSPC and CRPC is as follows:

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Financial difficulties due to the disease and treatment were quite high, ranging from 12% in Sweden, 16% in Canada and Spain, 34% in the US, and 46% in Brazil. As follows is a summary of the PROMs stratified by country:

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Dr. Rencsok concluded her presentation assessing patient reported outcomes from the IRONMAN registry with the following take-home messages:

  • Men with advanced prostate cancer experience a range of quality of life detriments that impair overall health
  • While at baseline, many of these measures were similar among men with mHSPC and CRPC, it is important to continue to monitor these metrics over time to examine changes in quality of life associated with disease progression and treatments
  • A longer-term goal is to identify opportunities for intervention to improve quality of life and potentially improve survival

Presented by: Emily Rencsok, Harvard Medical School, Boston, MA

Co-Authors: Daniel George, Philip W. Kantoff, Paul Villanti, Jake Vinson, Travis A. Gerke, Terry Hyslop, Lorelei A Mucci 

Written by: Zachary Klaassen, MD, MSc – Urologic Oncologist, Assistant Professor of Urology, Georgia Cancer Center, Augusta University/Medical College of Georgia, @zklaassen_md on Twitter during the 2022 American Society of Clinical Oncology Genitourinary (ASCO GU) Cancers Symposium, Thursday Feb 17 – Saturday Feb 19, 2022  

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