title: Variation in use of androgen suppression with external-beam radiotherapy for nonmetastatic prostate cancer.
abstract: OBJECTIVE
  To describe practice patterns associated with androgen suppression (AS) stratified by disease risk group in patients undergoing external-beam radiotherapy (EBRT) for localized prostate cancer.
  
  
  METHODS
  We identified 2,184 low-risk, 2,339 intermediate-risk, and 2,897 high-risk patients undergoing EBRT for nonmetastatic prostate cancer diagnosed between January 1, 2004, and December 31, 2005, in the linked Surveillance, Epidemiology, and End Results-Medicare database. We examined the association of patient, clinical, and demographic characteristics with AS use by multivariate logistic regression.
  
  
  RESULTS
  The proportions of patients receiving AS for low-risk, intermediate-risk, and high-risk prostate cancer were 32.2%, 56.3%, and 81.5%, respectively. AS use among men in the low-risk disease category varied widely, ranging from 13.6% in Detroit to 47.8% in Kentucky. We observed a significant decline in AS use between 2004 and 2005 within all three disease risk categories. Men aged ≥75 years or with elevated comorbidity levels were more likely to receive AS.
  
  
  CONCLUSIONS
  Our results identified apparent overuse and underuse of AS among men within the low-risk and high-risk disease categories, respectively. These results highlight the need for clinician and patient education regarding the appropriate use of AS. Practice patterns among intermediate-risk patients reflect the clinical heterogeneity of this population and underscore the need for better evidence to guide the treatment of these patients.
authors.affiliation: Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, USA. Swisher-Mcclure@uphs.upenn.edu
authors.forename: Samuel
authors.initials: S
authors.lastname: Swisher-McClure
authors.forename: Craig E
authors.initials: CE
authors.lastname: Pollack
authors.forename: John P
authors.initials: JP
authors.lastname: Christodouleas
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Guzzo
authors.forename: Naomi B
authors.initials: NB
authors.lastname: Haas
authors.forename: Neha
authors.initials: N
authors.lastname: Vapiwala
authors.forename: Justin E
authors.initials: JE
authors.lastname: Bekelman
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000726:Androgen Antagonists / Q000627:therapeutic use*; D003131:Combined Modality Therapy / Q000379:methods; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000592:standards*; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000097:blood / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy*; D012044:Regression Analysis; D012189:Retrospective Studies; D018570:Risk Assessment; D018426:SEER Program; D016896:Treatment Outcome; D014481:United States; D019564:Unnecessary Procedures
chemical_list: D000726:Androgen Antagonists; D017430:Prostate-Specific Antigen
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