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Adherence to guidelines for androgen deprivation therapy after radical prostatectomy: Swedish population-based study
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Urology. (Anna Bill-Axelson)
Regional Cancer Centre Uppsala Örebro Region, Uppsala, Sweden.
Regional Cancer Centre Uppsala Örebro Region, Uppsala, Sweden.; King’s College London, School of Medicine, Division of Cancer Studies, London, UK..
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Chemistry.ORCID iD: 0000-0003-3161-0402
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Abstract [en]

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.

Keywords [en]
Androgen deprivation therapy, Guidelines, Population-based study; Prostate cancer; Radical prostatectomy.
National Category
Urology and Nephrology
Research subject
Urology
Identifiers
URN: urn:nbn:se:uu:diva-354467OAI: oai:DiVA.org:uu-354467DiVA, id: diva2:1221362
Funder
Swedish Cancer Society, CAN 2008/598Available from: 2018-06-20 Created: 2018-06-20 Last updated: 2018-06-25Bibliographically approved
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Lycken, MagdalenaLarsson, AndersHolmberg, LarsBill-Axelson, Anna

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