Abstract
Introduction
We evaluated the incidence and predictors of the use of long-term (2-3 years) versus
shorter term androgen deprivation therapy (ADT) in radiation-managed men with high-risk
prostate cancer.
Patients and Methods
We identified 302 patients from the Dana-Farber Cancer Institute patient registry
who had been diagnosed with high-risk prostate cancer (T3a or prostate-specific antigen
[PSA] > 20 ng/mL or Gleason score 8-10) from 1993 to 2015. We assessed the intended
duration of ADT and used multivariable Cox regression to evaluate the predictors of
receiving a shorter course of ADT than recommended by the guidelines (< 2 years).
Results
The course of ADT intended by physicians increased after the 2008/2009 publication
of trials showing the superiority of long-term versus short-term ADT, with 43.5% intending ≥
2 years before versus 61.4% after (P = .014). Starting in 2010, 49.4% of patients actually received < 2 years of ADT.
The most common reasons for receipt of shorter course ADT were intolerance of ADT
side effects, patient comorbidity/age, the presence of T3a on magnetic resonance imaging
only as the sole high-risk feature, or participation in a clinical trial. Moderate
to severe comorbidity assessed using the Adult Comorbidity Evaluation-27 (adjusted
hazard ratio [AHR] = 2.94), Gleason score < 8 (AHR = 5.66), and PSA < 20 ng/mL (AHR =
4.19) all predicted for receipt of shorter course ADT (P < .05 for all).
Conclusion
In a tertiary-care setting, the rates of long-course ADT for high-risk disease have
increased since the 2008/2009 trials supporting its use. However, approximately one
half of patients continued to receive shorter course ADT, often because of intolerance
of side effects, underlying comorbidity, or physician judgment about the aggressiveness
of the disease.
Keywords
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Article info
Publication history
Published online: December 16, 2015
Accepted:
December 9,
2015
Received:
July 21,
2015
Identification
Copyright
© 2016 Elsevier Inc. All rights reserved.
