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

Int J Radiat Oncol Biol Phys. 2017 Jun 1;98(2):338-343. doi: 10.1016/j.ijrobp.2017.02.020. Epub 2017 Feb 21.

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 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.

MeSH terms

  • Academic Medical Centers / statistics & numerical data
  • Academic Medical Centers / trends
  • Adult
  • Aged
  • Aged, 80 and over
  • Androgen Antagonists / therapeutic use*
  • Brachytherapy / statistics & numerical data
  • Cancer Care Facilities / statistics & numerical data
  • Cancer Care Facilities / trends
  • Community Health Centers / statistics & numerical data
  • Community Health Centers / trends
  • Cryotherapy / statistics & numerical data
  • Databases, Factual / statistics & numerical data
  • Humans
  • Logistic Models
  • Male
  • Middle Aged
  • National Cancer Institute (U.S.) / statistics & numerical data
  • Neoplasm Grading
  • Proportional Hazards Models
  • Prostatectomy / statistics & numerical data
  • Prostatic Neoplasms / drug therapy*
  • Prostatic Neoplasms / epidemiology
  • Prostatic Neoplasms / radiotherapy
  • Prostatic Neoplasms / surgery
  • Radiotherapy / statistics & numerical data
  • Risk
  • United States / epidemiology

Substances

  • Androgen Antagonists