Adherence to guidelines for androgen deprivation therapy after radical prostatectomy: Swedish population-based study

Abstract

Background: Androgen deprivation therapy (ADT) is a non-curative but essential treatment of prostate cancer with severe side effects. Therefore, both over- and underuse should be avoided. We investigated adherence to guidelines for ADT following radical prostatectomy through Swedish population-based data.

Material and methods: We used the database Uppsala/Örebro PSA cohort (UPSAC) to study men with localised or locally advanced prostate cancer at diagnosis (clinical stage T1–T3, N0–NX, M0–MX, and prostate-specific antigen (PSA) <50 ng/ml) who underwent radical prostatectomy 1997–2012. 114 men were treated with ADT and selected as cases; 1140 men with no ADT at the index date were selected as controls within 4-year strata of year of radical prostatectomy. All men with a biochemical recurrence and a PSA doubling time <12 months and/or a Gleason score of 8–10 were considered to have an indication for ADT according to the European Association of Urology (EAU) guidelines.

Results: No indication for ADT was found in 37% of the cases. Among these, 88% had clinical stage T1–2 at diagnosis, 57% had a biopsy Gleason score 2–6, 98% had an expected remaining lifetime over 10 years, 12% received castration, and 88% received antiandrogen monotherapy. 2% of controls were found to have an indication for ADT, and 96% of these had an expected remaining lifetime over 10 years.

Conclusion: Our results indicate that overtreatment with ADT after radical prostatectomy is common, whereas undertreatment is unusual. Interventions to improve adherence to guidelines are needed to avoid unnecessary side-effects and long treatment durations with ADT.

Keywords:

• Androgen deprivation therapy
• guidelines
• population-based study
• prostate cancer
• radical prostatectomy

Acknowledgements

This study was made possible by the work of the National Prostate Cancer Register of Sweden (NPCR) steering group: Pär Stattin (chairman), Ingela Frank Lissbrant, Camilla Thellenberg, Johan Styrke, Hampus Nugin, Lennart Åström, Stefan Carlsson, Marie Hjälm-Eriksson, David Robinson, Mats Andén, Ola Bratt, Maria Nyberg, Olof Ståhl, Tomas Jiborn, Hans Joelsson, Gert Malmberg, Olof Akre, Per Fransson, Johan Stranne, Jonas Hugosson, Eva Johansson, Magnus Törnblom, Fredrik Jäderling, Fredrik Sandin, Karin Hellström. The work of the clinical laboratories in the region of Uppsala/Örebro was indispensable for the study.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This study was supported by the Swedish Cancer Society [Grant numbers CAN 2008/598, CAN 2014/1275, and CAN 2016/466]; and the Percy Falk foundation. The funding sources had no influence on study design, data collection, data analysis, data interpretation, writing of the report, or decision to submit the article for publication.