Increasing use of gonadotropin-releasing hormone agonists for the treatment of localized prostate carcinoma.
BACKGROUND
The role of androgen deprivation therapy in prostate carcinoma is controversial in earlier stages of disease. The authors examined the time trends and patterns of use for androgen deprivation in the form of gonadotropin-releasing hormone (GnRH) agonists or orchiectomy, in population-based tumor registries.


METHODS
Data were obtained from the linked Surveillance, Epidemiology and End Results-Medicare database. A total of 100,274 men with prostate carcinoma diagnosed from 1991 through 1999 were selected. The main outcome was the proportion of men who received >/= 1 dose of a GnRH agonist in the first 6 months of diagnosis. This was plotted by year and stratified for age, grade, stage as well as primary versus adjuvant usage. Multiple logistic regression was used to examine predictors of GnRH agonist use in the subset of patients with localized cancer.


RESULTS
There was a consistent increase in GnRH agonist use by year for all ages, stages, and grades. Even in men >/= 80 years with localized stage and low to moderate grade tumors, primary GnRH agonist use increased over the study period, from 3.7% in 1991 to 30.9% in 1999 (P < 0.001). The multivariable analysis showed that significant variability in GnRH agonist use existed among SEER geographic regions.


CONCLUSIONS
The use of GnRH agonists for prostate carcinoma increased dramatically during the 1990s. This increase occurred across all stages and histologic grades of prostate carcinoma, and was greatest in patients >/= 80 years.
Shahinian
Vahakn B
VB
Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas 77555-0562, USA. vbshahin@utmb.edu
Kuo
Yong-fang
YF
Freeman
Jean L
JL
Orihuela
Eduardo
E
Goodwin
James S
JS
D000368:Aged; D000369:Aged, 80 and over; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use*; D019992:Databases as Topic; D005300:Fertility Agents, Female / Q000819:agonists; D007987:Gonadotropin-Releasing Hormone / Q000819:agonists*; D017273:Goserelin / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D009367:Neoplasm Staging; D009919:Orchiectomy; D011237:Predictive Value of Tests; D011471:Prostatic Neoplasms / Q000188:drug therapy* / Q000556:secondary / Q000601:surgery; D012042:Registries; D018426:SEER Program; D013997:Time Factors; D016896:Treatment Outcome
D018931:Antineoplastic Agents, Hormonal; D005300:Fertility Agents, Female; D017273:Goserelin; D007987:Gonadotropin-Releasing Hormone