Abstract
Background
There are many FDA-approved drugs for advanced prostate cancer (PC), yet public interest in these drugs is not well understood. We compared public interest and state-level predictors of interest in five common oral adjunctive hormonal therapies.
Methods
Google Trends™ was queried for: “Enzalutamide”, “Abiraterone Acetate”, “Bicalutamide”, “Apalutamide”, and “Darolutamide” in the United States from January 2004 to November 2022. Data are presented as relative search index (RSI) by month. RSI ranges from 0 to 100 with 100 being peak popularity, 50 being half of the peak popularity, and 0 representing insufficient data to be determined.
Results
Several drugs abruptly increased in popularity following FDA approval including abiraterone, enzalutamide, and apalutamide. All drugs decreased in popularity from January 2020 to July 2020, corresponding with the COVID-19 pandemic. In the most recent 5 years, enzalutamide and abiraterone were the most common searched drugs, with bicalutamide a close 3rd place. States that did not expand Medicaid were significantly more likely to have bicalutamide as the top search drug vs. states that expanded Medicaid (p = 0.012). Across all states with data (n = 39), higher bicalutamide RSIs were significantly associated with lower household income (r = 0.385, p = 0.02) and greater percent of uninsured adults (r = 0.426, p = 0.007). This is the first study using Google Trends to compare advanced PC drugs by search popularity.
Conclusions
Despite the emergence of more effective medications, bicalutamide remains relatively popular, particularly in states with lower household income, more uninsured adults, or those that did not expand Medicaid, possibly due to its lower cost.
This is a preview of subscription content, access via your institution
Access options
Subscribe to this journal
Receive 4 print issues and online access
$259.00 per year
only $64.75 per issue
Rent or buy this article
Prices vary by article type
from$1.95
to$39.95
Prices may be subject to local taxes which are calculated during checkout



Data availability
The data that support the findings of this study are available from the corresponding author, SD, upon reasonable request.
References
Desai K, McManus JM, Sharifi N. Hormonal therapy for prostate cancer. Endocr Rev. 2021;42:354–73. https://doi.org/10.1210/endrev/bnab002.
Mori K, Mostafaei H, Pradere B, Motlagh RS, Quhal F, Laukhtina E, et al. Apalutamide, enzalutamide, and darolutamide for non-metastatic castration-resistant prostate cancer: a systematic review and network meta-analysis. Int J Clin Oncol. 2020;25:1892–900. https://doi.org/10.1007/s10147-020-01777-9.
Vaishampayan UN, Heilbrun LK, Monk P 3rd, Tejwani S, Sonpavde G, Hwang C, et al. Clinical efficacy of enzalutamide vs bicalutamide combined with androgen deprivation therapy in men with metastatic hormone-sensitive prostate cancer: a randomized clinical trial. JAMA Netw Open. 2021;4:e2034633. https://doi.org/10.1001/jamanetworkopen.2020.34633.
Koukourakis MI, Kakouratos C, Kalamida D, Mitrakas A, Pouliliou S, Xanthopoulou E, et al. Comparison of the effect of the antiandrogen apalutamide (ARN-509) versus bicalutamide on the androgen receptor pathway in prostate cancer cell lines. Anticancer Drugs. 2018;29:323–33. https://doi.org/10.1097/cad.0000000000000592.
Ueda T, Shiraishi T, Ito S, Ohashi M, Matsugasumi T, Yamada Y, et al. Abiraterone acetate versus bicalutamide in combination with gonadotropin releasing hormone antagonist therapy for high risk metastatic hormone sensitive prostate cancer. Sci Rep. 2021;11:10094. https://doi.org/10.1038/s41598-021-89609-2.
Siemens DR, Klotz L, Heidenreich A, Chowdhury S, Villers A, Baron B, et al. Efficacy and safety of enzalutamide vs bicalutamide in younger and older patients with metastatic castration resistant prostate cancer in the TERRAIN trial. J Urol. 2018;199:147–54. https://doi.org/10.1016/j.juro.2017.08.080.
Lowrance WT, Breau RH, Chou R, Chapin BF, Crispino T, Dreicer R, et al. Advanced prostate cancer: AUA/ASTRO/SUO guideline PART I. J Urol. 2021;205:14–21. https://doi.org/10.1097/ju.0000000000001375.
Lowrance WT, Breau RH, Chou R, Chapin BF, Crispino T, Dreicer R, et al. Advanced prostate cancer: AUA/ASTRO/SUO guideline PART II. J Urol. 2021;205:22–9. https://doi.org/10.1097/ju.0000000000001376.
Basch E, Loblaw DA, Oliver TK, Carducci M, Chen RC, Frame JN, et al. Systemic therapy in men with metastatic castration-resistant prostate cancer:American Society of Clinical Oncology and Cancer Care Ontario clinical practice guideline. J Clin Oncol. 2014;32:3436–48. https://doi.org/10.1200/jco.2013.54.8404.
KFF. 2022/04/21/T16:15:42+00:00. 2022. https://www.kff.org/statedata/.
Danila DC, Rathkopf DE, Morris MJ, Slovin SF, Schwartz LH, Farmer K, et al. Abiraterone acetate and prednisone in patients (Pts) with progressive metastatic castration resistant prostate cancer (CRPC) after failure of docetaxel-based chemotherapy. J Clin Oncol. 2008;26:5019. https://doi.org/10.1200/jco.2008.26.15_suppl.5019.
FDA approves abiraterone acetate in combination with prednisone for high-risk metastatic castration-sensitive prostate cancer. FDA. 2019. https://www.fda.gov/drugs/resources-information-approved-drugs/fda-approves-abiraterone-acetate-combination-prednisone-high-risk-metastatic-castration-sensitive.
Drug Approval Package: Xtandi (enzalutamide) NDA # 203415. 2012. https://www.accessdata.fda.gov/drugsatfda_docs/nda/2012/203415Orig1s000Approv.pdf.
FDA approves apalutamide for non-metastatic castration-resistant prostate cancer. FDA. 2019. https://www.fda.gov/drugs/resources-information-approved-drugs/fda-approves-apalutamide-non-metastatic-castration-resistant-prostate-cancer.
United States - COVID-19 Overview - Johns Hopkins. Johns Hopkins Coronavirus Resource Center. 2022. https://coronavirus.jhu.edu/map.html.
KFF. 2022/11/09/T14:44:01+00:00. 2022. https://www.kff.org/medicaid/issue-brief/status-of-state-medicaid-expansion-decisions-interactive-map/.
Chopra A, Georgieva M, Lopes G, Yeo CM, Haaland B. Abiraterone or enzalutamide in advanced castration-resistant prostate cancer: an indirect comparison. Prostate. 2017;77:639–46. https://doi.org/10.1002/pros.23309.
Kang M, Jeong CW, Kwak C, Ku JH, Kim HH. Comparing the clinical efficacy of abiraterone acetate, enzalutamide, and orteronel in patients with metastatic castration-resistant prostate cancer by performing a network meta-analysis of eight randomized controlled trials. Oncotarget. 2017;8:59690–7. https://doi.org/10.18632/oncotarget.17741.
Carvalho RM, Santos LDN, Ramos PM, Machado CJ, Acioly P, Frattini SC, et al. Bicalutamide and the new perspectives for female pattern hair loss treatment: what dermatologists should know. J Cosmet Dermatol. 2022;21:4171–5. https://doi.org/10.1111/jocd.14773.
Data.Medicaid.gov. State Drug Utilization Data 2021. Accessed August 21, 2023. https://data.medicaid.gov/dataset/eec7fbe6-c4c4-5915-b3d0-be5828ef4e9d.
Ali AM, Cobran EK, Young HN. Barriers associated with access to prescription medications in patients diagnosed with type 2 diabetes mellitus treated at federally qualified health centers. Pharmacy. 2022;10. https://doi.org/10.3390/pharmacy10040079.
West JC, Wilk JE, Rae DS, Muszynski IS, Stipec MR, Alter CL, et al. Medicaid prescription drug policies and medication access and continuity: findings from ten states. Psychiatr Serv. 2009;60:601–10. https://doi.org/10.1176/ps.2009.60.5.601.
Anawalt BD. Chapter 140 - Gynecomastia. In: Jameson JL, De Groot LJ, de Kretser DM, Giudice LC, Grossman AB, Melmed S, et al., editors. Endocrinology: adult and pediatric, 7th ed. Philadelphia: W.B. Saunders; 2016. p. 2421–30.e5.
Randolph JF Jr. Gender-affirming hormone therapy for transgender females. Clin Obstet Gynecol. 2018;61:705–21. https://doi.org/10.1097/grf.0000000000000396.
Acknowledgements
SD was supported by the Patient-Centered Outcomes Research Training in Urologic and Gynecologic Cancers (PCORT UroGynCan: T32CA251072). JD was supported by NIH grants TL1 DK132768 and U2C DK 129496. GCG was supported by the Department of Defense Health Disparities Research Fellowship. NAF was supported by an NIH grant T32CA240172. JG was supported by an 2022 PCF Young Investigator Award, Department of Defense Health Disparity Research Award W81XWH-19-1-0748, and American Cancer Society Research Scholar Grant RSG-18-018-01-CPHPS.
Author information
Authors and Affiliations
Contributions
SD: Conceptualization, Methodology, Investigation, Formal analysis, Data Curation. NAF: Writing – original draft, Writing – review & editing. JD: Writing – original draft, Writing – review & editing. GCG: Writing – original draft, Writing – review & editing. JG: Conceptualization, Methodology, Investigation, Writing – original draft, Writing – review & editing. EP: Conceptualization, Methodology, Investigation, Writing – original draft, Writing – review & editing. WA: Conceptualization, Methodology, Investigation, Writing – original draft, Writing – review & editing. SJF: Conceptualization, Methodology, Investigation, Writing – original draft, Writing – review & editing, Supervision, Project administration.
Corresponding author
Ethics declarations
Competing interests
SJF – consultant for Bayer, Astellas, Astra Zeneca, Janssen, Pfizer, Merck, Sanofi and speaker for Astra Zeneca and Sanofi. EP – receives research funding from Pfizer/Astellas, speaker for Bayer and Myovant, advisor for Bayer and Janssen. JG – Consultant for Janssen, Myovant, Astellas, Pfizer, Bayer, Elsevier, Exelixis, and Incyte. WA – Consultant for Bayer, Janssen, Pfizer, Astellas, Myovant. The other authors declare no competing interests.
Additional information
Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Das, S., Friedrich, N.A., Daniels, J. et al. Relative search popularity of five advanced prostate cancer medications using Google Trends. Prostate Cancer Prostatic Dis (2023). https://doi.org/10.1038/s41391-023-00716-9
Received:
Revised:
Accepted:
Published:
DOI: https://doi.org/10.1038/s41391-023-00716-9