Mousa Ahmad, Nguyen David-Dan, Lalani Aly-Khan, Satkunasivam Raj, Aminoltejari Khatereh, Hird Amanda, Roy Soumyajit, Morgan Scott C, Malone Shawn, Kokorovic Andrea, Lavallée Luke T, Huynh Melissa, Shayegan Bobby, Jiang Di Maria, Gotto Geofrey, Breau Rodney H, Kulkarni Girish S, Zlotta Alexandre, Wallis Christopher J D
Division of Urology, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
Department of Medical Oncology, Juravinski Cancer Center, McMaster University, Hamilton, Ontario, Canada.
Cancer. 2025 Jan 1;131(1):e35606. doi: 10.1002/cncr.35606. Epub 2024 Oct 13.
Androgen-deprivation therapy (ADT) remains a cornerstone in treatment for patients with advanced prostate cancer. ADT is associated with several adverse effects, including osteoporosis, metabolic syndrome, and cardiovascular events, leading to guidelines recommending routine testing to monitor for these toxicities. There is a lack of data assessing adherence to these recommendations.
The authors conducted a retrospective cohort study using administrative data from Ontario, Canada between 2008 and 2021. They identified all older men (aged 65 years and older) who received ADT for prostate cancer using comprehensive provincial health databases. The primary outcomes were the use of testing for lipids, dysglycemia (glucose), bone health serum, and bone density between 6 weeks before and 1 year after the initiation of ADT.
In total, 29,097 patients were examined, of whom 52.8% were prescribed ADT by urologists, 37.9% were prescribed ADT by radiation oncologists, 2.8% were prescribed ADT by medical oncologists, and 2.4% were prescribed ADT by other physicians. Adherence to guidelines was low: only 21.3% of patients received a bone density scan, 41.2% underwent bone health-related serum tests, 51.3% completed a lipid profile, and 65.9% underwent dysglycemia testing within 1 year of diagnosis. Overall, only 11.9% of patients received all of the recommended investigations. Adherence to testing did not appear to improve over time (2008-2021) or with guideline publication. Patient (age) and physician (specialty) factors had important associations with adherence to testing.
Most patients receiving ADT for prostate cancer do not receive recommended testing to monitor for treatment-related toxicity. Further study is required to address barriers to therapeutic monitoring of men on ADT and to reduce treatment-associated adverse events.
雄激素剥夺疗法（ADT）仍然是晚期前列腺癌患者治疗的基石。ADT与多种不良反应相关，包括骨质疏松、代谢综合征和心血管事件，这导致指南建议进行常规检测以监测这些毒性反应。目前缺乏评估对这些建议依从性的数据。
作者利用加拿大安大略省2008年至2021年的行政数据进行了一项回顾性队列研究。他们使用省级综合健康数据库确定了所有因前列腺癌接受ADT治疗的老年男性（65岁及以上）。主要结局是在ADT开始前6周和开始后1年内进行血脂、血糖异常（血糖）、骨健康血清学和骨密度检测的情况。
总共检查了29097名患者，其中52.8%由泌尿科医生开具ADT处方，37.9%由放射肿瘤学家开具ADT处方，2.8%由医学肿瘤学家开具ADT处方，2.4%由其他医生开具ADT处方。对指南的依从性较低：在诊断后1年内，只有21.3%的患者接受了骨密度扫描，41.2%的患者进行了骨健康相关血清学检测，51.3%的患者完成了血脂检查，65.9%的患者进行了血糖异常检测。总体而言，只有11.9%的患者接受了所有推荐的检查。随着时间推移（2008 - 2021年）或指南发布，检测依从性似乎并未改善。患者（年龄）和医生（专业）因素与检测依从性有重要关联。
大多数接受ADT治疗的前列腺癌患者未接受推荐的检测以监测治疗相关毒性。需要进一步研究以解决ADT男性患者治疗监测的障碍，并减少治疗相关不良事件。
