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|Title:||Variation in national use of long-term ADT by disease aggressiveness among men with unfavorable-risk prostate cancer|
|Citation:||Journal of the National Comprehensive Cancer Network, 2016; 14(4):421-428|
|Publisher:||Jones and Barlett Publishers|
|Vinayak Muralidhar, Brandon Arvin Virgil Mahal, Gally Reznor, Toni K. Choueiri, Christopher Sweeney, Neil E. Martin, Peter F. Orio, Yu-Wei Chen, Michelle Daniel Nezolosky, Karen E. Hoffman, Felix Yi-Chung Feng, Quoc-Dien Trinh, Paul L. Nguyen|
|Abstract:||The current NCCN Clinical Practice Guidelines in Oncology for Prostate Cancer recommend long-term androgen deprivation therapy (ADT) for all men with high-risk prostate cancer treated with external-beam radiation therapy (EBRT). We determined whether the use of long-term ADT varied by the recently defined subcategories of high-risk disease (favorable, other, and very high) versus unfavorable intermediate-risk disease.We identified 5,524 patients with unfavorable-risk prostate cancer diagnosed from 2004 to 2007 and managed with EBRT using the SEER-Medicare linked database. Patients were stratified by risk group: unfavorable intermediate-risk, favorable high-risk (previously defined and validated as clinical stage T1c, Gleason score of 4 + 4 = 8, and prostate-specific antigen [PSA] level <10 ng/mL, or clinical stage T1c, Gleason score of 6, and PSA level >20 ng/mL), very-high-risk (clinical stage T3b-T4 or primary Gleason pattern 5), or other high risk (ie, neither favorable nor very high). We used multivariable competing risks regression to estimate the rates of long-term (≥2 years) ADT by group.Men with favorable high-risk prostate cancer were significantly less likely to receive long-term ADT than those with other high-risk disease (15.4% vs 24.6%, adjusted hazard ratio [AHR], 0.68; 95% CI, 0.60-0.76;P<.001), and similarly likely as those with unfavorable intermediate-risk disease (AHR, 1.10; 95% CI, 0.99-1.23;P=.087). Other high-risk disease was less likely to receive long-term ADT than very high-risk cancer (24.6% vs 30.8%; AHR, 0.83; 95% CI, 0.74-0.93;P=.002).Despite current guidelines, patients with EBRT-managed high-risk prostate cancer received significantly different rates of long-course ADT based on subclassification. Our results suggest that oncologists view these patients as a heterogeneous group with favorable high-risk cancer warranting less aggressive therapy than other high-risk or very high-risk disease.|
|Keywords:||Androgen deprivation therapy; African-American men; cardiovascular-disease; radiation-therapy; trial; radiotherapy; suppression; mortality; duration|
|Rights:||Copyright © 2016 by the National Comprehensive Cancer Network.|
|Appears in Collections:||Medicine publications|
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