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Adherence to guidelines for androgen deprivation therapy after radical prostatectomy: Swedish population-based study
Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.
Regional Cancer Centre Uppsala Örebro Region, Uppsala, Sweden.
Regional Cancer Centre Uppsala Örebro Region, Uppsala, Sweden; King's College London, School of Cancer and Pharmaceutical Sciences, Translational Oncology and Urology Research (TOUR), London, UK.
Department of Medical Sciences, Clinical Chemistry, University University, Uppsala, Sweden.
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2020 (English)In: Scandinavian journal of urology, ISSN 2168-1805, E-ISSN 2168-1813, Vol. 54, no 3, p. 208-214Article in journal (Refereed) Published
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. 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.

Place, publisher, year, edition, pages
Informa Healthcare, 2020. Vol. 54, no 3, p. 208-214
Keywords [en]
Androgen deprivation therapy, guidelines, population-based study, prostate cancer, radical prostatectomy
National Category
Urology and Nephrology
Identifiers
URN: urn:nbn:se:oru:diva-81456DOI: 10.1080/21681805.2020.1750475ISI: 000531986800001PubMedID: 32338176Scopus ID: 2-s2.0-85084376690OAI: oai:DiVA.org:oru-81456DiVA, id: diva2:1428108
Funder
Swedish Cancer Society, CAN 2008/598 CAN 2014/1275 CAN 2016/466
Note

Funding Agency:

Percy Falk foundation

Available from: 2020-05-04 Created: 2020-05-04 Last updated: 2020-12-08Bibliographically approved

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Andrén, Ove

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