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Adherence to guidelines for androgen deprivation therapy after radical prostatectomy: Swedish population-based study.
Lycken, Magdalena; Drevin, Linda; Garmo, Hans; Larsson, Anders; Andrén, Ove; Holmberg, Lars; Bill-Axelson, Anna.
Afiliación
  • Lycken M; Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.
  • Drevin L; Regional Cancer Centre Uppsala Örebro Region, Uppsala, Sweden.
  • Garmo H; Regional Cancer Centre Uppsala Örebro Region, Uppsala, Sweden.
  • Larsson A; King's College London, School of Cancer and Pharmaceutical Sciences, Translational Oncology and Urology Research (TOUR), London, UK.
  • Andrén O; Department of Medical Sciences, Clinical Chemistry, University University, Uppsala, Sweden.
  • Holmberg L; School of Medical Sciences, Örebro University, Örebro, Sweden.
  • Bill-Axelson A; Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.
Scand J Urol ; 54(3): 208-214, 2020 Jun.
Article en En | MEDLINE | ID: mdl-32338176
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.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Prostatectomía / Neoplasias de la Próstata / Orquiectomía / Adhesión a Directriz / Antagonistas de Andrógenos Tipo de estudio: Guideline / Observational_studies Límite: Aged / Aged80 / Humans / Male / Middle aged País/Región como asunto: Europa Idioma: En Revista: Scand J Urol Año: 2020 Tipo del documento: Article País de afiliación: Suecia Pais de publicación: Suecia
Texto completo
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Prostatectomía / Neoplasias de la Próstata / Orquiectomía / Adhesión a Directriz / Antagonistas de Andrógenos Tipo de estudio: Guideline / Observational_studies Límite: Aged / Aged80 / Humans / Male / Middle aged País/Región como asunto: Europa Idioma: En Revista: Scand J Urol Año: 2020 Tipo del documento: Article País de afiliación: Suecia Pais de publicación: Suecia