Timing of Androgen Deprivation Therapy: Some Questions Answered, Others Not

Extract

The objective of the article by Shahinian et al. ( 1 ) in this issue of the Journal was to determine the factors involved in the use of androgen deprivation therapy—specifically, to distinguish patient and tumor characteristics from physician decision making as a determinant for the use of androgen deprivation therapy. For this retrospective study, they linked the Surveillance, Epidemiology, and End Results (SEER) and Medicare databases to identify 1802 urologists who provided care within 1 year of prostate cancer diagnosis for 61 717 patients who were older than 66 years.

Of the 61 717 patients, 31.4% received androgen deprivation therapy within 6 months of diagnosis. The study population was chronologically divided into two cohorts: those patients diagnosed in the years 1997–1999 and those diagnosed between January 1, 1992, and January 1, 1997. This division was made because information from randomized control trials became available in 1997 that showed a survival advantage was associated with the addition of androgen deprivation therapy to radiation therapy, compared with radiation therapy alone. The 1997–1999 cohort was further divided into a high-risk or “evidence-based” group that included patients with clinical stage T4 tumors and patients receiving radiation therapy who had either T3 or T2 tumors with high-grade histology, defined as having a Gleason score of 8–10. Receipt of androgen deprivation therapy by such patients was considered to be evidence based, according to the results of the randomized control trials available in 1997.The other patients, whose tumor characteristics did not fall into the advanced-stage or grade criteria, were categorized in an uncertain-benefit group for androgen deprivation therapy.