Disparity in care for men with advanced prostate cancer

For Canadian men living with advanced prostate cancer that has spread to their bones, access to bone-targeted treatment may depend on where they live rather than on evidence-based standard of care.

For example, men who live in some provinces, such as Alberta, must pay for bone-targeted therapies out of their own pocket or through private insurance, but men living in Ontario or Quebec do not because the drug is covered for them.

When left untreated, cancer that has spread to the bone can lead to serious and debilitating complications that can cause pain, disability and even death. To prevent debilitating complications, it’s important to have access to the most appropriate bone-targeting treatment at the earliest sign of metastases when the agent can be most helpful.

Across Canada, bone-modifying agents for prostate cancer are covered through different mechanisms, such as hospitals, provincial drug plans, and cancer agencies. CCSN is advocating for wider access to bone-targeting agents in provinces where access is limited or where only one class of treatment is available. The following chart indicates which provinces provide coverage and where unreasonable coverage gaps continue to exist.                                                                                   

Province	denosumab	zoledronic acid
British Columbia	Covered (palliative only)	Covered (palliative only)
Saskatchewan	Covered	Covered
Alberta	Not covered	Not covered
Manitoba	Covered	Covered
Ontario	Covered	Covered
Quebec	Covered	Not covered
Newfoundland and Labrador	Not covered	Covered
New Brunswick	Covered	Covered
Nova Scotia	Covered	Covered
Prince Edward Island	Not covered	Not covered

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Class: RANK Ligand Inhibitors

Denosumab is used for reducing the risk of developing cancer-related complications like broken bones and/or bone pain that need surgery or radiation. It’s administered as a single injection under the skin (subcutaneous) once every four weeks.

Class: Bisphosphonates

Zoledronic acid is indicated for the treatment of patients with documented bone metastases from solid tumours (including prostate cancer, breast cancer, lung cancer, renal cell carcinoma and other solid tumours) to prevent or delay potential complications from the bone lesions. It’s administered to patients through intravenous infusion (IV infusion).