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

• 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. Our aim was to investigate adherence to guidelines for ADT following radical prostatectomy through Swedish population-based data. Methods: We used the database PSA Uppsala/Örebro 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. Totally 114 men were treated with ADT and selected as cases; 1140 men with no ADT at the index date were selected as controls within four-year strata of time of radical prostatectomy. All men with a PSA doubling time <12 months and/or a biopsy 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 39% of the cases. Among these men, 89% had tumour stage (T-stage) 1-2 at diagnosis, 58% had a biopsy Gleason score 2-6, 98% had an expected remaining lifetime over ten years, 16% received castration, and 84% received antiandrogen monotherapy. Among the controls 5% were found to have an indication for ADT, and 98% of these men had an expected remaining lifetime over ten years.Conclusion: Our results indicate that overtreatment with ADT after radical prostatectomyis common, whereas undertreatment is unusual. Interventions to improve adherence to guidelines are needed to avoid unnecessary side-effects and long treatment durations with ADT.

Ämnesord

MEDICIN OCH HÄLSOVETENSKAP  -- Klinisk medicin -- Urologi och njurmedicin (hsv//swe)

MEDICAL AND HEALTH SCIENCES  -- Clinical Medicine -- Urology and Nephrology (hsv//eng)

Nyckelord

Androgen deprivation therapy

Guidelines

Population-based study; Prostate cancer; Radical prostatectomy.

Urologi

Urology

Publikations- och innehållstyp

vet (ämneskategori)

ovr (ämneskategori)