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Title: National Trends and Predictors of Androgen Deprivation Therapy Use in Low-Risk Prostate Cancer

Abstract

Purpose: Androgen deprivation therapy (ADT) is not recommended for low-risk prostate cancer because of its lack of benefit and potential for harm. We evaluated the incidence and predictors of ADT use in low-risk disease. Methods and Materials: Using the National Cancer Database, we identified 197,957 patients with low-risk prostate cancer (Gleason score of 3 + 3 = 6, prostate-specific antigen level <10 ng/mL, and cT1-T2a) diagnosed from 2004 to 2012 with complete demographic and treatment information. We used multiple logistic regression to evaluate predictors of ADT use and Cox regression to examine its association with all-cause mortality. Results: Overall ADT use decreased from 17.6% in 2004 to 3.5% in 2012. In 2012, 11.5% of low-risk brachytherapy patients and 7.6% of external beam radiation therapy patients received ADT. Among 82,352 irradiation-managed patients, predictors of ADT use included treatment in a community versus academic cancer program (adjusted odds ratio [AOR], 1.60; 95% confidence interval [CI], 1.50-1.71; P<.001; incidence, 14.0% vs 6.0% in 2012); treatment in the South (AOR, 1.51), Midwest (AOR, 1.81), or Northeast (AOR, 1.90) versus West (P<.001); and brachytherapy use versus external beam radiation therapy (AOR, 1.32; 95% CI, 1.27-1.37; P<.001). Among 25,196 patients who did not receive local therapy, predictors of primary ADT use includedmore » a Charlson-Deyo comorbidity score of ≥2 versus 0 (AOR, 1.42; 95% CI, 1.06-1.91; P=.018); treatment in a community versus academic cancer program (AOR, 1.61; 95% CI, 1.37-1.90; P<.001); and treatment in the South (AOR, 1.26), Midwest (AOR, 1.52), or Northeast (AOR, 1.28) versus West (P≤.008). Primary ADT use was associated with increased all-cause mortality in patients who did not receive local therapy (adjusted hazard ratio, 1.28; 95% CI, 1.14-1.43; P<.001) after adjustment for age and comorbidity. Conclusions: ADT use in low-risk prostate cancer has declined nationally but may remain an issue of concern in certain populations and regions.« less

Authors:
 [1];  [2];  [3];  [4]; ; ; ; ; ;  [5];  [3];  [3];  [6];  [3];  [3];  [7];  [3];  [5];  [3];  [5] more »;  [3];  [5];  [3]; « less
  1. Harvard Medical School, Boston, Massachusetts (United States)
  2. Department of Medicine, Harvard Medical School, Boston, Massachusetts (United States)
  3. (United States)
  4. Harvard Radiation Oncology Program, Boston, Massachusetts (United States)
  5. Department of Radiation Oncology, Harvard Medical School, Boston, Massachusetts (United States)
  6. Department of Medical Oncology, Harvard Medical School, Boston, Massachusetts (United States)
  7. Division of Urological Surgery, Harvard Medical School, Boston, Massachusetts (United States)
Publication Date:
OSTI Identifier:
22649930
Resource Type:
Journal Article
Resource Relation:
Journal Name: International Journal of Radiation Oncology, Biology and Physics; Journal Volume: 98; Journal Issue: 2; Other Information: Copyright (c) 2017 Elsevier Science B.V., Amsterdam, The Netherlands, All rights reserved.; Country of input: International Atomic Energy Agency (IAEA)
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; ANDROGENS; BRACHYTHERAPY; EXTERNAL BEAM RADIATION THERAPY; NEOPLASMS; PATIENTS; PROSTATE

Citation Formats

Yang, David D., Muralidhar, Vinayak, Brigham and Women's Hospital, Boston, Massachusetts, Mahal, Brandon A., Labe, Shelby A., Nezolosky, Michelle D., Vastola, Marie E., King, Martin T., Martin, Neil E., Orio, Peter F., Dana-Farber Cancer Institute, Boston, Massachusetts, Brigham and Women's Hospital, Boston, Massachusetts, Choueiri, Toni K., Dana-Farber Cancer Institute, Boston, Massachusetts, Brigham and Women's Hospital, Boston, Massachusetts, Trinh, Quoc-Dien, Brigham and Women's Hospital, Boston, Massachusetts, Spratt, Daniel E., University of Michigan, Ann Arbor, Michigan, Hoffman, Karen E., The University of Texas MD Anderson Cancer Center, Houston, Texas, Feng, Felix Y., Departments of Urology & Medicine and Helen Diller Family Comprehensive Cancer Center, University of California at San Francisco, San Francisco, California, and and others. National Trends and Predictors of Androgen Deprivation Therapy Use in Low-Risk Prostate Cancer. United States: N. p., 2017. Web. doi:10.1016/J.IJROBP.2017.02.020.
Yang, David D., Muralidhar, Vinayak, Brigham and Women's Hospital, Boston, Massachusetts, Mahal, Brandon A., Labe, Shelby A., Nezolosky, Michelle D., Vastola, Marie E., King, Martin T., Martin, Neil E., Orio, Peter F., Dana-Farber Cancer Institute, Boston, Massachusetts, Brigham and Women's Hospital, Boston, Massachusetts, Choueiri, Toni K., Dana-Farber Cancer Institute, Boston, Massachusetts, Brigham and Women's Hospital, Boston, Massachusetts, Trinh, Quoc-Dien, Brigham and Women's Hospital, Boston, Massachusetts, Spratt, Daniel E., University of Michigan, Ann Arbor, Michigan, Hoffman, Karen E., The University of Texas MD Anderson Cancer Center, Houston, Texas, Feng, Felix Y., Departments of Urology & Medicine and Helen Diller Family Comprehensive Cancer Center, University of California at San Francisco, San Francisco, California, & and others. National Trends and Predictors of Androgen Deprivation Therapy Use in Low-Risk Prostate Cancer. United States. doi:10.1016/J.IJROBP.2017.02.020.
Yang, David D., Muralidhar, Vinayak, Brigham and Women's Hospital, Boston, Massachusetts, Mahal, Brandon A., Labe, Shelby A., Nezolosky, Michelle D., Vastola, Marie E., King, Martin T., Martin, Neil E., Orio, Peter F., Dana-Farber Cancer Institute, Boston, Massachusetts, Brigham and Women's Hospital, Boston, Massachusetts, Choueiri, Toni K., Dana-Farber Cancer Institute, Boston, Massachusetts, Brigham and Women's Hospital, Boston, Massachusetts, Trinh, Quoc-Dien, Brigham and Women's Hospital, Boston, Massachusetts, Spratt, Daniel E., University of Michigan, Ann Arbor, Michigan, Hoffman, Karen E., The University of Texas MD Anderson Cancer Center, Houston, Texas, Feng, Felix Y., Departments of Urology & Medicine and Helen Diller Family Comprehensive Cancer Center, University of California at San Francisco, San Francisco, California, and and others. Thu . "National Trends and Predictors of Androgen Deprivation Therapy Use in Low-Risk Prostate Cancer". United States. doi:10.1016/J.IJROBP.2017.02.020.
@article{osti_22649930,
title = {National Trends and Predictors of Androgen Deprivation Therapy Use in Low-Risk Prostate Cancer},
author = {Yang, David D. and Muralidhar, Vinayak and Brigham and Women's Hospital, Boston, Massachusetts and Mahal, Brandon A. and Labe, Shelby A. and Nezolosky, Michelle D. and Vastola, Marie E. and King, Martin T. and Martin, Neil E. and Orio, Peter F. and Dana-Farber Cancer Institute, Boston, Massachusetts and Brigham and Women's Hospital, Boston, Massachusetts and Choueiri, Toni K. and Dana-Farber Cancer Institute, Boston, Massachusetts and Brigham and Women's Hospital, Boston, Massachusetts and Trinh, Quoc-Dien and Brigham and Women's Hospital, Boston, Massachusetts and Spratt, Daniel E. and University of Michigan, Ann Arbor, Michigan and Hoffman, Karen E. and The University of Texas MD Anderson Cancer Center, Houston, Texas and Feng, Felix Y. and Departments of Urology & Medicine and Helen Diller Family Comprehensive Cancer Center, University of California at San Francisco, San Francisco, California and and others},
abstractNote = {Purpose: Androgen deprivation therapy (ADT) is not recommended for low-risk prostate cancer because of its lack of benefit and potential for harm. We evaluated the incidence and predictors of ADT use in low-risk disease. Methods and Materials: Using the National Cancer Database, we identified 197,957 patients with low-risk prostate cancer (Gleason score of 3 + 3 = 6, prostate-specific antigen level <10 ng/mL, and cT1-T2a) diagnosed from 2004 to 2012 with complete demographic and treatment information. We used multiple logistic regression to evaluate predictors of ADT use and Cox regression to examine its association with all-cause mortality. Results: Overall ADT use decreased from 17.6% in 2004 to 3.5% in 2012. In 2012, 11.5% of low-risk brachytherapy patients and 7.6% of external beam radiation therapy patients received ADT. Among 82,352 irradiation-managed patients, predictors of ADT use included treatment in a community versus academic cancer program (adjusted odds ratio [AOR], 1.60; 95% confidence interval [CI], 1.50-1.71; P<.001; incidence, 14.0% vs 6.0% in 2012); treatment in the South (AOR, 1.51), Midwest (AOR, 1.81), or Northeast (AOR, 1.90) versus West (P<.001); and brachytherapy use versus external beam radiation therapy (AOR, 1.32; 95% CI, 1.27-1.37; P<.001). Among 25,196 patients who did not receive local therapy, predictors of primary ADT use included a Charlson-Deyo comorbidity score of ≥2 versus 0 (AOR, 1.42; 95% CI, 1.06-1.91; P=.018); treatment in a community versus academic cancer program (AOR, 1.61; 95% CI, 1.37-1.90; P<.001); and treatment in the South (AOR, 1.26), Midwest (AOR, 1.52), or Northeast (AOR, 1.28) versus West (P≤.008). Primary ADT use was associated with increased all-cause mortality in patients who did not receive local therapy (adjusted hazard ratio, 1.28; 95% CI, 1.14-1.43; P<.001) after adjustment for age and comorbidity. Conclusions: ADT use in low-risk prostate cancer has declined nationally but may remain an issue of concern in certain populations and regions.},
doi = {10.1016/J.IJROBP.2017.02.020},
journal = {International Journal of Radiation Oncology, Biology and Physics},
number = 2,
volume = 98,
place = {United States},
year = {Thu Jun 01 00:00:00 EDT 2017},
month = {Thu Jun 01 00:00:00 EDT 2017}
}