Symptoms and Impacts in Metastatic Castration-Resistant Prostate Cancer: Qualitative Findings from Patient and Physician Interviews

  • Stefan Holmstrom
  • Shevani Naidoo
  • James Turnbull
  • Emily HawrylukEmail author
  • Jean Paty
  • Robert Morlock
Original Research Article



There is little information available on health-related quality of life in patients with chemotherapy-naïve metastatic castration-resistant prostate cancer. This study aimed to develop a conceptual model that describes patients’ experiences of living with this condition.


This was a cross-sectional, non-interventional qualitative research study. Sixty-minute semi-structured interviews were conducted with physicians experienced in treating metastatic castration-resistant prostate cancer and with chemotherapy-naïve patients with metastatic castration-resistant prostate cancer. Interviews were audio-recorded and transcripts were analysed to identify the key symptoms and impacts on quality of life. Results were used to expand a previously published conceptual model for non-metastatic castration-resistant prostate cancer.


Three physicians and 19 patients with metastatic castration-resistant prostate cancer were interviewed. Physicians identified several symptoms frequently mentioned by their patients: fatigue, bone pain, anxiety, stress, depression and interference with daily activities. The most salient symptoms emerging from the patient interviews were urinary frequency and urgency, fatigue, pain/stiffness and sexual dysfunction. The most salient impacts were interference with daily activities, frustration, anxiety and sleep problems. Compared with non-metastatic castration-resistant prostate cancer, some symptoms and impacts in metastatic castration-resistant prostate cancer were more common and rated as more disturbing (e.g. fatigue, pain, urinary frequency, interference with daily activities and frustration). New concepts that were added to the non-metastatic castration-resistant prostate cancer model, to more accurately reflect the experiences of patients with metastatic disease, were enlarged breasts, muscle loss/deconditioning, inability to focus/mental slowing, body image perception, interference with work and lack of ambition/motivation.


Chemotherapy-naïve patients with metastatic castration-resistant prostate cancer experience a substantial burden from their condition. Furthermore, as castration-resistant prostate cancer progresses from the non-metastatic stage to the early metastatic (pre-chemotherapy) stage, certain symptoms become more common and disturb patients’ lives to a greater extent. The resulting conceptual model for metastatic castration-resistant prostate cancer highlights areas that are not adequately assessed with current patient-reported outcome instruments.



Medical writing assistance was provided by Jonathan Plumb and Nicola French from Bioscript Medical, and editorial assistance was provided by Lauren Smith and Stephanie Rippon from Complete HealthVizion.

Author contributions

SH, JT, EH and JP contributed to the study design. JT and EH were involved in patient recruitment and data collection. JT, EH, JP and RM provided the data analysis. All authors contributed to the data interpretation. RM was involved in the writing of the manuscript. All of the authors provided critical reviews and approved the final manuscript.

Compliance with Ethical Standards


The study was funded by Astellas. Medical writing and editorial assistance was funded by Astellas Pharma Inc.

Conflict of interest

Stefan Holmstrom is an employee of Astellas. Shevani Naidoo was an employee of Astellas at the time the research was conducted. James Turnbull is an employee of Pfizer and was an employee of IQVIA at the time the research was conducted. Emily Hawryluk and Jean Paty are employees of IQVIA, which received consulting fees from Astellas. Robert Morlock received personal fees from Astellas during the conduct of the research; he has also received personal fees from Abbot Medical Optics, Ironwood and Genentech outside the submitted work.

Ethics approval

The study and all interview materials were reviewed and approved by the New England Independent Review Board (no. 20160817) and conducted in accordance with the Declaration of Helsinki and the regulations of the US Food and Drug Administration.

Consent to participate

All patients provided informed online consent that was verbally confirmed before the start of the interview. As part of the consent procedure, patients agreed that the results could be presented, provided that individual patient data could not be identified.


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Copyright information

© Springer Nature Switzerland AG 2018

Authors and Affiliations

  1. 1.Astellas Pharma Inc.Leidenthe Netherlands
  2. 2.Astellas Pharma Inc.ChertseyUK
  3. 3.IQVIANew YorkUSA
  4. 4.Astellas Pharma Inc.NorthbrookUSA

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