Department of Surgical Sciences, Uppsala University, Sweden.
Regional Cancer Centre, Uppsala Örebro Region, Sweden; King's College London, School of Medicine, Division of Cancer Studies, London, UK.
Eur J Cancer. 2014 Jul;50(10):1789-1798. doi: 10.1016/j.ejca.2014.03.279. Epub 2014 Apr 12.
Many men diagnosed with localised prostate cancer will eventually be treated with androgen deprivation therapy (ADT). ADT is associated with adverse effects and its timing is controversial. Data on patterns of use are scarce. We describe patterns of ADT use, defined as castration (medical and surgical) or antiandrogen monotherapy initiated after primary treatment, in a population-based cohort.
Data were extracted from the population-based Prostate Cancer data Base Sweden (PCBaSe). Totally 45,147 men diagnosed between 1997 and 2009 with clinical stage T1-2, N0-NX, M0-MX and prostate specific antigen (PSA)<50ng/ml without primary ADT were included. Outcomes in the period 2006 through 2010 were analysed using a period analysis approach.
The cumulative incidence of castration at 10years after diagnosis was 11.6% (95% confidence interval (CI), 11.0-12.2%). The corresponding proportion of antiandrogen monotherapy was 10.8% (95% CI, 10.2-11.4%). Castration was the dominant therapy among men on deferred treatment. The probability of receiving castration rather than antiandrogen monotherapy increased with age. Estimated median durations of castration ranged from 4years in the deferred treatment high-risk group to 17years in the prostatectomy low-risk group. The main limitation was the lack of information on progression to metastatic disease and PSA at the time for initiation of ADT.
When initiated early after curative treatment, the duration of castration can be decades. The findings indicate that more accurate tools are necessary to guide which men should be selected for ADT as secondary treatment.
许多被诊断为局限性前列腺癌的男性最终将接受雄激素剥夺疗法（ADT）治疗。ADT 会引起不良反应，其应用时机存在争议。目前有关其应用模式的数据有限。我们描述了基于人群的队列中 ADT 的应用模式，定义为初始治疗后开始的去势（药物和手术）或抗雄激素单药治疗。
数据来自基于人群的前列腺癌数据库瑞典（PCBaSe）。共纳入 1997 年至 2009 年间诊断为临床分期 T1-2、N0-NX、M0-MX 和前列腺特异性抗原（PSA）<50ng/ml 且无初始 ADT 的 45147 例男性。使用期间分析方法分析 2006 年至 2010 年的结局。
诊断后 10 年的去势累积发生率为 11.6%（95%置信区间，11.0-12.2%）。相应的抗雄激素单药治疗比例为 10.8%（95%置信区间，10.2-11.4%）。在延迟治疗的男性中，去势是主要治疗方法。接受去势而非抗雄激素单药治疗的概率随年龄增长而增加。估计的去势中位持续时间从延迟治疗高危组的 4 年到前列腺切除术低危组的 17 年不等。主要限制是缺乏有关开始 ADT 时转移性疾病和 PSA 进展的信息。
在根治性治疗后早期开始时，去势的持续时间可能长达数十年。这些发现表明，需要更准确的工具来指导选择哪些男性应作为二线治疗选择接受 ADT。
