Patterns of prescription and adherence to European Association of Urology guidelines on androgen deprivation therapy in prostate cancer: an Italian multicentre cross-sectional analysis from the Choosing Treatment for Prostate Cancer (CHOICE) study.
To evaluate both the patterns of prescription of androgen deprivation therapy (ADT) in patients with prostate cancer (PCa) and the adherence to European Association of Urology (EAU) guidelines for ADT prescription.



The Choosing Treatment for Prostate Cancer (CHOICE) study was an Italian multicentre cross-sectional study conducted between December 2010 and January 2012. A total of 1 386 patients, treated with ADT for PCa (first prescription or renewal of ADT), were selected. With regard to the EAU guidelines on ADT, the cohort was categorized into discordant ADT (Group A) and concordant ADT (Group B).



The final cohort included 1 075 patients with a geographical distribution including North Italy (n = 627, 58.3%), Central Italy (n = 233, 21.7%) and South Italy (n = 215, 20.0%). In the category of patients treated with primary ADT, a total of 125 patients (56.3%) were classified as low risk according to D'Amico classification. With regard to the EAU guidelines, 285 (26.51%) and 790 patients (73.49%) were classified as discordant (Group A) and concordant (Group B), respectively. In Group A, patients were more likely to receive primary ADT (57.5%, 164/285 patients) than radical prostatectomy (RP; 30.9%, 88/285 patients), radiation therapy (RT; 6.7%, 19/285 patients) or RP + RT (17.7%, 14/285 patients; P < 0.01). Multivariate logistic regression analysis, adjusted for clinical and pathological variables, showed that patients from Central Italy (odds ratio [OR] 2.86; P < 0.05) and South Italy (OR 2.65; P < 0.05) were more likely to receive discordant ADT.



EAU guideline adherence for ADT was low in Italy and was influenced by geographic area. Healthcare providers and urologists should consider these results in order to quantify the inadequate use of ADT and to set policy strategies to overcome this risk.
Department of Urology, University of Catania, Catania, Italy.
Giuseppe
G
Morgia
Department of Urology, University of Catania, Catania, Italy.
Giorgio Ivan
GI
Russo
Department of Urology, Sant' Andrea Hospital, 'La Sapienza' University of Roma, Roma, Italy.
Andrea
A
Tubaro
S.O. Oncologia Radioterapica, Pordenone, Italy.
Roberto
R
Bortolus
Urology, Presidio Ospedaliero Gradenigo, Torino, Italy.
Donato
D
Randone
Radiotherapy, IRCC Candiolo, Torino, Italy.
Pietro
P
Gabriele
Radiotherapy, A.O. Santa Maria, Terni, Italy.
Fabio
F
Trippa
Department of Urology, University of Padova, Padova, Italy.
Filiberto
F
Zattoni
Department of Urology, University of Perugia, Perugia, Italy.
Massimo
M
Porena
Department of Urology, Università Federico II of Napoli, Napoli, Italy.
Vincenzo
V
Mirone
Department of Urology, University of Firenze, Firenze, Italy.
Sergio
S
Serni
Urologia I, Azienda Ospedaliera San Paolo, Milano, Italy.
Alberto
A
Del Nero
Radiotherapy, ASL of Cagliari, Cagliari, Italy.
Giancarlo
G
Lay
Radiotherapy, AOU University S. Giovanni Battista Molinette, Torino, Italy.
Umberto
U
Ricardi
Department of Urology, University of Milano, Milano, Italy.
Francesco
F
Rocco
Urology, University Hospital 'Maggiore della Carità', Novara, Italy.
Carlo
C
Terrone
Urology, University of Bari, Bari, Italy.
Arcangelo
A
Pagliarulo
Urology, Ospedale Generale Regionale F. Miulli, Acquaviva delle Fonti, Italy.
Giuseppe
G
Ludovico
Department of Urology, University Tor Vergata, Roma, Italy.
Giuseppe
G
Vespasiani
Urology, Ospedale Civile Ramazzini, Carpi, Italy.
Maurizio
M
Brausi
Department of Urology, University of Brescia, Brescia, Italy.
Claudio
C
Simeone
Department of Surgery, Urology Clinic, AOUI Verona, Verona, Italy.
Giovanni
G
Novella
Department of Urology, University of Genova, Genova, Italy.
Giorgio
G
Carmignani
Urology, Centro Uro-Andrologico La CURA, Acireale, Italy.
Rosario
R
Leonardi
Radiotherapy, IRCC Candiolo, Torino, Italy.
Paola
P
Pinnarò
Radiotherapy, AO S. Giovanni Addolorata, Roma, Italy.
Ugo
U
De Paula
Radiotherapy, Istituto Nazionale per la Ricerca, Genova, Italy.
Renzo
R
Corvò
Department of Urology, University of Chieti, Chieti, Italy.
Raffaele
R
Tenaglia
Department of Urology, University of Trieste, Trieste, Italy.
Salvatore
S
Siracusano
Radiotherapy, Policlinico Universitario Agostino Gemelli, Roma, Italy.
Giovanna
G
Mantini
Department of Surgical Sciences, Città della Salute e della Scienza, University of Torino, Torino, Italy.
Paolo
P
Gontero
Urology, Fondazione Istituto San Raffaele - G. Giglio di Cefalù, Cefalù, Italy.
Gianfranco
G
Savoca
Department of Experimental and Clinical Medical Sciences, University of Udine, Udine, Italy.
Vincenzo
V
Ficarra
D000368:Aged; D000369:Aged, 80 and over; D000726:Androgen Antagonists / Q000627:therapeutic use*; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D003430:Cross-Sectional Studies; D019983:Guideline Adherence; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology / Q000517:prevention & control*; D018579:Patient Selection; D017410:Practice Guidelines as Topic; D055656:Prescriptions; D017430:Prostate-Specific Antigen / Q000097:blood*; D011471:Prostatic Neoplasms / Q000097:blood / Q000188:drug therapy* / Q000453:epidemiology; D013997:Time Factors; D014572:Urology / Q000639:trends*
D000726:Androgen Antagonists; D018931:Antineoplastic Agents, Hormonal; D017430:Prostate-Specific Antigen
European Association of Urology; adherence; androgen deprivation therapy; guidelines; prostate cancer