Division of Urology, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
Department of Medicine, University Health Network, University of Toronto, Toronto, Ontario, Canada.
J Urol. 2021 Oct;206(4):933-941. doi: 10.1097/JU.0000000000001876. Epub 2021 May 25.
Phase-III randomized control trial evidence suggests intermittent androgen deprivation therapy (IADT) is not significantly inferior to continuous androgen deprivation therapy (ADT) for patients with prostate cancer (PC). However, clinical practice and guidelines differ in their recommendations. We evaluate real-world utilization and practice patterns of IADT.
Ontario men ≥65 years of age with PC who initiated ADT for ≥3 months were identified (1997-2017). Lapses in ADT ≥6 months (initial gap) and ≥3 months (subsequent gaps) were used to classify IADT. Neoadjuvant/adjuvant therapy was excluded. Disease stage adjustment was completed for patients with likely metastatic disease based on de novo presentation with ADT. Patient and physician predictors of IADT were analyzed using multivariable logistic regression.
We identified 8,544 patients with 1,715 having previously received local therapy. Among all patients, 16.4% received IADT. This ranged from 11.4%-24.8% across health-planning regions and increased to 26.6% in those with previous local therapy. Mean followup was 8.3 years. Patients with prior local therapy (OR 1.85, 95% CI 1.59-2.17, p <0.001) and those in the highest income quintile (OR 1.32, 95% CI 1.08-1.60, p=0.005) had increased odds of receiving IADT. Radiation oncologists were more likely to use IADT than urologists (OR 1.99, 95% CI 1.59-2.50, p <0.001), as were physicians with more experience (≥10 years in practice: OR 1.44, 95% CI 1.11-1.88, p=0.007). In specialty-stratified analyses, case volume was significantly associated with IADT for radiation oncologists (highest quartile: OR 1.73, 95% CI 1.14-2.62, p=0.009).
IADT remains underutilized for patients with PC who ≥65 years of age with only 1 in 4 to 1 in 6 eligible patients receiving this form of care. Clinical, sociodemographic and physician characteristics play an important role in treatment selection.
III 期随机对照临床试验证据表明，间歇性雄激素剥夺疗法（IADT）与连续雄激素剥夺疗法（ADT）相比，在前列腺癌（PC）患者中的疗效并无显著差异。然而，临床实践和指南在推荐方面存在差异。我们评估了 IADT 的真实世界应用和实践模式。
在 1997 年至 2017 年间，确定了≥65 岁的安大略省男性患者，他们接受 ADT 治疗≥3 个月。采用初始间隔≥6 个月（初始间隙）和后续间隔≥3 个月（后续间隙）来对 IADT 进行分类。排除新辅助/辅助治疗。对于可能患有转移性疾病的患者，根据 ADT 的初诊表现，进行疾病分期调整。使用多变量逻辑回归分析 IADT 的患者和医生预测因素。
我们确定了 8544 名接受 ADT 治疗≥3 个月的患者，其中 1715 名患者曾接受局部治疗。所有患者中，有 16.4%接受了 IADT。在各卫生规划区域，IADT 的比例为 11.4%-24.8%，而在接受过局部治疗的患者中，IADT 的比例增加到 26.6%。平均随访时间为 8.3 年。有局部治疗史的患者（OR 1.85，95%CI 1.59-2.17，p<0.001）和收入最高五分位数的患者（OR 1.32，95%CI 1.08-1.60，p=0.005）接受 IADT 的可能性更高。放射肿瘤学家比泌尿科医生更有可能使用 IADT（OR 1.99，95%CI 1.59-2.50，p<0.001），经验更丰富的医生（≥10 年的行医经验：OR 1.44，95%CI 1.11-1.88，p=0.007）也是如此。在专科分层分析中，对于放射肿瘤学家，病例量与 IADT 显著相关（最高四分位数：OR 1.73，95%CI 1.14-2.62，p=0.009）。
对于≥65 岁的前列腺癌患者，仅有 1/4 至 1/6 的符合条件的患者接受 IADT，这种疗法的使用率仍然较低。临床、社会人口学和医生特征在治疗选择中起着重要作用。
