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

Figures & data

Table 1. Characteristics of the study population.

	Cases (n = 114)	Controls (n = 1140)
	No. (%)	No. (%)
PSA level at diagnosis (Q1–Q3)
	9 (6–15)	7 (5–10)
T-stage at prostate cancer diagnosis
T1	44 (39)	692 (61)
T2	62 (54)	404 (35)
T3	7 (6)	25 (2)
TX	0 (0)	17 (1)
Other/missing	1 (1)	2 (0)
Gleason score at prostate cancer diagnosis
2–6	48 (42)	776 (68)
7	45 (39)	296 (26)
8–10	19 (17)	52 (5)
Missing	2 (2)	16 (1)
Year of radical prostatectomy
1997–2000	20 (18)	200 (18)
2001–2003	21 (18)	180 (16)
2004–2006	29 (25)	345 (30)
2007–2009	20 (18)	231 (20)
2010–2012	24 (21)	184 (16)
PSA level at inclusion date (Q1–Q3)^a
	3 (1–9)	0.1 (0.03–0.1)
Age at inclusion date (years)^a
<65	21 (18)	366 (32)
65–69	29 (25)	370 (32)
70–74	31 (27)	264 (23)
75–79	25 (22)	100 (9)
80+	8 (7)	40 (4)
Educational level at inclusion date^a^,^b
Low	33 (29)	332 (29)
Middle	53 (46)	465 (41)
High	27 (24)	342 (30)
Missing	1 (1)	1 (0)
Marital status at inclusion date^a
Married	84 (74)	827 (73)
Divorced	14 (12)	169 (15)
Widower	5 (4)	61 (5)
Never married	11 (10)	83 (7)
Charlson Comorbidity Index at inclusion date^a^,^c
0	83 (73)	903 (79)
1	16 (14)	147 (13)
2	10 (9)	61 (5)
3+	5 (4)	29 (3)
ADT category
Castration	31 (27)	N/A
Antiandrogen	83 (73)	N/A

^a The inclusion date was set as the date of androgen deprivation therapy (ADT) initiation for the cases.

^b Educational level was categorised according to years of education: Low: ≤9 years. Middle: 10–12 years. High: ≥13 years.

^c Comorbidity was categorised according to the Charlson Comorbidity Index; 0: None. 1: Mild. 2: Moderate. 3+: Severe.

ADT: androgen deprivation therapy; PSA: prostate-specific antigen; Q: quartile; T-stage: tumour stage.

Figure 1. Adherence to the European Association of Urology (EAU) guidelines and the Swedish guidelines for androgen deprivation therapy following radical prostatectomy. Proportion of men who had a PSA ≥ 0.2 ng/ml (PSA relapse) and at least one of the following at the start of androgen deprivation therapy (ADT): a PSADT <6 months, and/or a PSADT 6–12 months, and/or a radical prostatectomy specimen Gleason score 8–10, and/or a biopsy Gleason score 8–10, and/or a PSA ≥5 ng/ml. If the criteria above were fulfilled, the proportion was labelled as adherent for the cases and non-adherent for the controls. Proportion of men with no PSA-tests. Proportion of men who had a PSA relapse and none of the above criteria at the start of ADT. Proportion of men with no PSA relapse at the start of ADT. PSA: prostate-specific antigen; PSADT: PSA doubling time; RP-GS: radical prostatectomy specimen Gleason score; GS: biopsy Gleason score.

Table 2. Characteristics of the cases.

	EAU guidelines^a			Swedish guidelines^b
	Adherent (n = 67)	Non-adherent (n = 42)	No PSA tests^c (n = 5)	Adherent (n = 71)	Non-adherent (n = 38)	No PSA tests^c (n = 5)
T-stage at prostate cancer diagnosis^d
T1	25 (37)	16 (38)	3 (60)	23 (32)	18 (47)	3 (60)
T2	40 (60)	21 (50)	1 (20)	45 (63)	16 (42)	1 (20)
T3	2 (3)	4 (10)	1 (20)	3 (4)	3 (8)	1 (20)
TX	0 (0)	0 (0)	0 (0)	0 (0)	0 (0)	0 (0)
Other/missing	0 (0)	1 (2)	0 (0)	0 (0)	1 (3)	0 (0)
Gleason score at prostate cancer diagnosis
2–6	22 (33)	24 (57)	2 (40)	27 (38)	19 (50)	2 (40)
7	28 (42)	15 (36)	2 (40)	27 (38)	16 (42)	2 (40)
8–10	17 (25)	1 (2)	1 (20)	17 (24)	1 (3)	1 (20)
Missing	0 (0)	2 (5)	0 (0)	0 (0)	2 (5)	0 (0)
Expected remaining lifetime^e
<10 years	7 (10)	1 (2)	1 (20)	5 (7)	3 (8)	1 (20)
>10 years	60 (90)	41 (98)	4 (80)	66 (93)	35 (92)	4 (80)
ADT category^f
Castration	23 (34)	5 (12)	3 (60)	24 (34)	4 (11)	3 (60)
Antiandrogen	44 (66)	37 (88)	2 (40)	47 (66)	34 (89)	2 (40)

^a The cases labelled as adherent to the European Association of Urology (EAU) guidelines included men with at least one measurement of prostate-specific antigen (PSA) ≥0.2 ng/ml at the start of androgen deprivation therapy (ADT). Furthermore, they had either a prostate-specific antigen doubling time (PSADT) <12 months, and/or a Gleason score 8–10 at the start of ADT.

^b The cases labelled as adherent to the Swedish guidelines included men with at least one measurement of PSA ≥0.2 ng/ml at the start of ADT. Furthermore, they had either a PSADT <6 months, and/or a Gleason score 8–10, and/or a PSA ≥5 ng/ml at the start of ADT.

^c PSA: prostate-specific antigen.

^d T-stage: tumour stage.

^e Expected remaining lifetime was considered as more than 10 years for the following combinations of age and comorbidity: <70 years and any Charlson Comorbidity Index (CCI), 70–74 years and CCI ≤2, 75–79 years and CCI ≤1, and ≥80 years and CCI = 0.

^f ADT: androgen deprivation therapy.

Table 3. Characteristics of the controls.

	EAU guidelines^a			Swedish guidelines^b
	Adherent (n = 899)	Non-adherent (n = 24)	No PSA tests^c (n = 217)	Adherent (n = 900)	Non-adherent (n = 23)	No PSA tests^c (n = 217)
T-stage at prostate cancer diagnosis^d
T1	542 (60)	15 (62)	135 (62)	542 (60)	15 (65)	135 (62)
T2	329 (37)	9 (38)	66 (30)	331 (37)	7 (30)	66 (30)
T3	18 (2)	0 (0)	7 (3)	17 (2)	1 (4)	7 (3)
TX	9 (1)	0 (0)	8 (4)	9 (1)	0 (0)	8 (4)
Other/missing	1 (0)	0 (0)	1 (0)	1 (0)	0 (0)	1 (0)
Gleason score at prostate cancer diagnosis
2–6	615 (68)	9 (38)	152 (70)	614 (68)	10 (43)	152 (70)
7	233 (26)	7 (29)	56 (26)	235 (26)	5 (22)	56 (26)
8–10	36 (4)	8 (33)	8 (4)	36 (4)	8 (35)	8 (4)
Missing	15 (2)	0 (0)	1 (0)	15 (2)	0 (0)	1 (0)
Expected remaining lifetime^e
<10 years	31 (3)	1 (4)	15 (7)	29 (3)	3 (13)	15 (7)
>10 years	868 (97)	23 (96)	202 (93)	871 (97)	20 (87)	202 (93)

^a The controls labelled as non-adherent to the European Association of Urology (EAU) guidelines included men with at least one measurement of prostate-specific antigen (PSA) ≥0.2 ng/ml at the start of androgen deprivation therapy (ADT). Furthermore, they had either a prostate-specific antigen doubling time (PSADT) <12 months, and/or a Gleason score 8–10 at the start of ADT.

^b The controls labelled as non-adherent to the Swedish guidelines included men with at least one measurement of PSA ≥ 0.2 ng/ml at the start of ADT. Furthermore, they had either a PSADT <6 months, and/or a Gleason score 8–10, and/or a PSA ≥5 ng/ml at the start of ADT.

^c PSA: prostate-specific antigen.

^d T-stage: tumour stage.

^e Expected remaining lifetime was considered as more than 10 years for the following combinations of age and comorbidity: <70 years and any Charlson Comorbidity Index (CCI), 70–74 years and CCI ≤2, 75–79 years and CCI ≤1, and ≥80 years and CCI = 0.