Liede Alexander, Hallett David C, Hope Kirsty, Graham Alex, Arellano Jorge, Shahinian Vahakn B
Center for Observational Research, Amgen Inc. , South San Francisco, California , USA.
Dalla Lana School of Public Health, University of Toronto , Toronto, Ontario , Canada.
ESMO Open. 2016 Mar 18;1(2):e000040. doi: 10.1136/esmoopen-2016-000040. eCollection 2016.
Continuous androgen deprivation therapy (CADT) is commonly used for patients with non-metastatic prostate cancer as primary therapy for high-risk disease, adjuvant therapy together with radiation or for recurrence after initial local therapy. Intermittent ADT (IADT), a recently developed alternative strategy for providing ADT, is thought to potentially reduce adverse effects, but little is known about practice patterns relating to it. We aimed to describe factors related to physicians' ADT use and modality for patients with non-metastatic prostate cancer.
A 45 min online survey was completed by urologists and oncologists responsible for treatment decisions for non-metastatic prostate cancer from 19 countries with high or increasing prevalence of non-metastatic prostate cancer.
There were 441 treating physicians who completed the survey which represented 99 177 patients with prostate cancer under their care, of which 76 386 (77%) had non-metastatic prostate cancer. Of patients with non-metastatic prostate cancer, 38% received ADT (37% gonadotropin-releasing hormone (GnRH), 2% orchiectomy); among patients on GnRH, 54% received CADT (≥6 without >3 months interruption), 23% IADT and 23% <6 months. Highest rates of ADT were reported among oncologists (62%) and in Eastern Europe (Czech Republic, Hungary and Poland). Prostate-specific antigen (PSA) levels (65%), Gleason score (52%) and treatment guidelines (48%) were the most common reasons for CADT whereas PSA levels (54%), patient request (48%), desire to maintain sexual function (40%), patient age and comorbidities (38%) were cited most frequently as reasons for IADT.
This international survey with 441 treating physicians from 19 countries showed that ADT is commonly used in treating patients with non-metastatic prostate cancer, and type of ADT is influenced by high-risk criteria (PSA and Gleason), treatment guidelines and patient preferences. IADT use was primarily driven by PSA levels, patient request and patient age/comorbidities, likely reflecting an attempt to minimise adverse effects of ADT in patients with lower risk tumours.
持续雄激素剥夺疗法（CADT）常用于非转移性前列腺癌患者，作为高危疾病的主要治疗方法、与放疗联合的辅助治疗或初始局部治疗后复发的治疗方法。间歇性雄激素剥夺疗法（IADT）是一种最近开发的提供雄激素剥夺疗法的替代策略，被认为可能减少不良反应，但关于其应用模式知之甚少。我们旨在描述与非转移性前列腺癌患者雄激素剥夺疗法使用及方式相关的因素。
来自19个非转移性前列腺癌患病率高或呈上升趋势国家的泌尿外科医生和肿瘤内科医生完成了一项45分钟的在线调查，这些医生负责非转移性前列腺癌的治疗决策。
有441名参与治疗的医生完成了调查，他们共诊治了99177例前列腺癌患者，其中76386例（77%）为非转移性前列腺癌。在非转移性前列腺癌患者中，38%接受了雄激素剥夺疗法（37%使用促性腺激素释放激素（GnRH），2%接受睾丸切除术）；在使用GnRH的患者中，54%接受持续雄激素剥夺疗法（≥6个月且中断不超过3个月），23%接受间歇性雄激素剥夺疗法，23%接受治疗时间<6个月。肿瘤内科医生（62%）和东欧国家（捷克共和国、匈牙利和波兰）报告的雄激素剥夺疗法使用率最高。前列腺特异性抗原（PSA）水平（65%）、 Gleason评分（52%）和治疗指南（48%）是持续雄激素剥夺疗法最常见的原因，而PSA水平（54%）、患者要求（48%）、维持性功能的愿望（40%）、患者年龄和合并症（38%）是间歇性雄激素剥夺疗法最常被提及的原因。
这项对来自19个国家的441名参与治疗的医生进行的国际调查显示，雄激素剥夺疗法常用于治疗非转移性前列腺癌患者，雄激素剥夺疗法的类型受高危标准（PSA和Gleason评分）、治疗指南和患者偏好的影响。间歇性雄激素剥夺疗法的使用主要由PSA水平、患者要求以及患者年龄/合并症驱动，这可能反映出在低风险肿瘤患者中尽量减少雄激素剥夺疗法不良反应的尝试。
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