Adherence to guidelines for androgen deprivation therapy after radical prostatectomy: Swedish population-based study.

Publisher: Medical Journals Sweden AB Country of Publication: Sweden NLM ID: 101587186 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 2168-1813 (Electronic) Linking ISSN: 21681805 NLM ISO Abbreviation: Scand J Urol Subsets: MEDLINE

Publication: 2023-: Uppsala, Sweden : Medical Journals Sweden AB
Original Publication: Colchester, Esssex : Informa Healthcare

Orchiectomy* ; Prostatectomy*; Androgen Antagonists/*therapeutic use ; Guideline Adherence/*statistics & numerical data ; Prostatic Neoplasms/*drug therapy ; Prostatic Neoplasms/*surgery; Aged ; Aged, 80 and over ; Combined Modality Therapy ; Humans ; Male ; Middle Aged ; Postoperative Period ; Sweden

Background: Androgen deprivation therapy (ADT) is a non-curative but essential treatment of prostate cancer with severe side effects. Therefore, both over- and underuse should be avoided. We investigated adherence to guidelines for ADT following radical prostatectomy through Swedish population-based data. Material and methods: We used the database Uppsala/Örebro PSA cohort (UPSAC) to study men with localised or locally advanced prostate cancer at diagnosis (clinical stage T1-T3, N0-NX, M0-MX, and prostate-specific antigen (PSA) <50 ng/ml) who underwent radical prostatectomy 1997-2012. 114 men were treated with ADT and selected as cases; 1140 men with no ADT at the index date were selected as controls within 4-year strata of year of radical prostatectomy. All men with a biochemical recurrence and a PSA doubling time <12 months and/or a Gleason score of 8-10 were considered to have an indication for ADT according to the European Association of Urology (EAU) guidelines. Results: No indication for ADT was found in 37% of the cases. Among these, 88% had clinical stage T1-2 at diagnosis, 57% had a biopsy Gleason score 2-6, 98% had an expected remaining lifetime over 10 years, 12% received castration, and 88% received antiandrogen monotherapy. 2% of controls were found to have an indication for ADT, and 96% of these had an expected remaining lifetime over 10 years. Conclusion: Our results indicate that overtreatment with ADT after radical prostatectomy is common, whereas undertreatment is unusual. Interventions to improve adherence to guidelines are needed to avoid unnecessary side-effects and long treatment durations with ADT.

Keywords: Androgen deprivation therapy; guidelines; population-based study; prostate cancer; radical prostatectomy

0 (Androgen Antagonists)

Date Created: 20200428 Date Completed: 20210318 Latest Revision: 20210318

20250114

10.1080/21681805.2020.1750475

32338176