uu.seUppsala University Publications
Change search
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf
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
Show others and affiliations
(English)Manuscript (preprint) (Other academic)
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
In thesis
1. Living and dying with prostate cancer: Population-based register studies
Open this publication in new window or tab >>Living and dying with prostate cancer: Population-based register studies
2018 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Tailored treatment with adequate timing is essential for the quality of prostate cancer care at all stages. Overtreatment should be avoided due to the side effects, but undertreatment may on the other hand lead to progression and death. This thesis aims to describe the patterns of use for non-curative treatments of prostate cancer, alongside the time trends of disease characteristics of men who die from prostate cancer. The work was based on the National Prostate Cancer Register of Sweden (NPCR).

The first study included 45 147 men. The cumulative incidence of castration was 11.6% at ten years after diagnosis, while it was 10.8% for antiandrogen monotherapy. Estimated median durations of castration ranged from four years in the deferred treatment high-risk group to seventeen years in the prostatectomy low-risk group. The second study included 114 cases and 1140 controls. Four men out of ten received androgen deprivation therapy although they had prostate-specific antigen doubling time ≥12 months and biopsy Gleason score ≤7, which was defined as non-adherence to the guidelines of the European Association of Urology. Most of these men had low-risk features at diagnosis. The third study included 8326 men. During the last year before death from prostate cancer, use of opioids increased from 30% to 72%. Men without close relatives and older men had lower probability to receive opioids. The fourth study included 45 850 men. During the study period of 1992 to 2012, the time trend showed a stage shift towards lower risk group at diagnosis, longer disease duration, and higher age at death among men who died from prostate cancer.

The first two studies indicate that overtreatment with androgen deprivation therapy is common after curative treatment, why interventions to improve adherence to guidelines are needed.  The third study indicates that men without close relatives and older men are disadvantaged with respect to treatment of cancer pain, why they need closer attention from health care providers. The findings in the fourth study may reflect the synergetic effects of prolonged lead time, increased life expectancy, and improvements in the management of prostate cancer during the last two decades.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2018. p. 65
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1474
Keywords
Androgen deprivation therapy; Palliative medicine; Population-based study; Prostate cancer.
National Category
Medical and Health Sciences
Research subject
Urology
Identifiers
urn:nbn:se:uu:diva-354470 (URN)978-91-513-0369-7 (ISBN)
Public defence
2018-09-07, Humanistiska teatern, Engelska parken, Uppsala, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2018-08-17 Created: 2018-06-20 Last updated: 2018-08-27

Open Access in DiVA

No full text in DiVA

Authority records BETA

Lycken, MagdalenaLarsson, AndersHolmberg, LarsBill-Axelson, Anna

Search in DiVA

By author/editor
Lycken, MagdalenaLarsson, AndersHolmberg, LarsBill-Axelson, Anna
By organisation
UrologyClinical ChemistryEndocrine Surgery
Urology and Nephrology

Search outside of DiVA

GoogleGoogle Scholar

urn-nbn

Altmetric score

urn-nbn
Total: 14 hits
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf