Fu Alex Z, Tsai Huei-Ting, Haque Reina, Ulcickas Yood Marianne, Van Den Eeden Stephen K, Cassidy-Bushrow Andrea E, Zhou Yingjun, Keating Nancy L, Smith Matthew R, Aaronson David S, Potosky Arnold L
Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, 3300 Whitehaven Street, NW, Suite 4100, Washington, DC, 20007, USA.
Kaiser Permanente Southern California, Pasadena, CA, USA.
World J Urol. 2016 Dec;34(12):1611-1619. doi: 10.1007/s00345-016-1823-5. Epub 2016 Apr 15.
The optimal use of androgen deprivation therapy as salvage treatment (sADT) for men after initial prostatectomy or radiotherapy for clinically localized prostate cancer is undefined. We describe patterns of sADT use and investigate clinical and sociodemographic characteristics of insured men who received sADT versus surveillance in managed care settings.
Using comprehensive electronic health records and cancer registry data from three integrated health plans, we identified all men with newly diagnosed clinically localized prostate cancer between 1995 and 2009 who received either prostatectomy (n = 16,445) or radiotherapy (n = 19,531) as their primary therapy. We defined sADT based on the timing of ADT following primary therapy and stage of cancer. We fit Cox proportional hazard models to identify sociodemographic characteristics and clinical factors associated with sADT.
With a median follow-up of 6 years (range 2-15 years), 13 % of men who underwent primary prostatectomy or radiotherapy received sADT. After adjusting for selected covariates, sADT was more likely to be used in men who were older (e.g., HR 1.70, 95 % CI 1.48-1.96 or HR 1.33, 95 % CI 1.17-1.52 for age 70+ relative to age 35-59 for primary prostatectomy or radiotherapy, respectively), were African-American, had a short PSA doubling time, had a higher pre-treatment risk of progression, had more comorbidities, and received adjuvant ADT for initial disease.
In men with localized prostate cancer in community practice initially treated with prostatectomy or radiotherapy, sADT after primary treatment was more frequent for men at greater risk of death from prostate cancer, consistent with practice guidelines.
对于临床局限性前列腺癌患者，在初次前列腺切除术后或放疗后，雄激素剥夺疗法作为挽救性治疗（sADT）的最佳使用方式尚不明确。我们描述了sADT的使用模式，并调查了在管理式医疗环境中接受sADT与接受监测的参保男性的临床和社会人口统计学特征。
利用来自三个综合健康计划的全面电子健康记录和癌症登记数据，我们识别出1995年至2009年间所有新诊断为临床局限性前列腺癌且接受前列腺切除术（n = 16,445）或放疗（n = 19,531）作为主要治疗的男性。我们根据初次治疗后ADT的时间和癌症分期来定义sADT。我们拟合Cox比例风险模型以识别与sADT相关的社会人口统计学特征和临床因素。
中位随访6年（范围2 - 15年），接受初次前列腺切除术或放疗的男性中有13%接受了sADT。在调整选定的协变量后，年龄较大的男性更有可能使用sADT（例如，对于初次前列腺切除术或放疗，相对于35 - 59岁的男性，70岁及以上男性的HR分别为1.70，95%CI 1.48 - 1.96或HR 1.33，95%CI 1.17 - 1.52），非裔美国人，PSA加倍时间短，初始疾病进展的预处理风险高，合并症更多，且因初始疾病接受辅助ADT。
在社区实践中最初接受前列腺切除术或放疗的局限性前列腺癌男性中，对于死于前列腺癌风险更高的男性，初次治疗后进行sADT更为频繁，这与实践指南一致。
