National trends and predictors for androgen deprivation therapy use in low-risk prostate cancer

Publication date: Available online 21 February 2017
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): David D. Yang, Vinayak Muralidhar, Brandon A. Mahal, Shelby A. Labe, Michelle D. Nezolosky, Marie E. Vastola, Martin T. King, Neil E. Martin, Peter F. Orio, Toni K. Choueiri, Quoc-Dien Trinh, Daniel E. Spratt, Karen E. Hoffman, Felix Y. Feng, Paul L. Nguyen
PurposeAndrogen deprivation therapy (ADT) is not recommended for low-risk prostate cancer due to its lack of benefit and potential for harm. We evaluated the incidence and predictors of ADT use in low-risk disease.Methods and MaterialsWe identified 197,957 patients in the National Cancer Database with low-risk prostate cancer (Gleason 3+3=6, PSA<10 ng/mL, and cT1-T2a) diagnosed from 2004 to 2012 with complete demographic and treatment information. We utilized multiple logistic regression to evaluate predictors of ADT use and Cox regression to examine its association with all-cause mortality.ResultsOverall ADT use decreased from 17.6% in 2004 to 3.5% in 2012. In 2012, 11.5% of low-risk brachytherapy and 7.6% of external beam radiation therapy (EBRT) patients received ADT. Among 82,352 radiation-managed patients, predictors of ADT use include treatment in a community vs. academic cancer program (adjusted odds ratio [AOR] 1.60, 95% CI 1.50-1.71, p<0.001; incidence 14.0% vs. 6.0% in 2012); treatment in the South (AOR 1.51), Midwest (AOR 1.81), or Northeast (AOR 1.90) vs. West (p<0.001); and brachytherapy use vs. EBRT (AOR 1.32, 1.27-1.37, p<0.001). Among 25,196 patients who did not receive local therapy, predictors of primary ADT use include Charlson-Deyo comorbidity score of 2+ vs. 0 (AOR 1.42, 1.06-1.91, p=0.018); treatment in a community vs. academic cancer program (AOR 1.61, 1.37-1.90, p<0.001); and treatment in the South (AOR 1.26), Midwest (AOR 1.52), or Northeast (AOR 1.28) vs. West (p≤0.008). Primary ADT use was associated with increased all-cause mortality in patients who did not receive local therapy (adjusted hazard ratio [AHR] 1.28, 1.14-1.43, p<0.001) after adjusting for age and comorbidity.ConclusionADT use in low-risk prostate cancer has declined nationally but may still remain an issue of concern in certain populations and regions.

Teaser

We evaluated the incidence and predictors of androgen deprivation therapy (ADT) use in low-risk prostate cancer from 2004 to 2012 using the National Cancer Database. Low-risk patients received ADT mostly as adjuvant therapy to radiation treatment. ADT use in low-risk patients has declined nationally but may still remain of concern in certain populations and regions.


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