title: Variation in National Use of Long-Term ADT by Disease Aggressiveness Among Men With Unfavorable-Risk Prostate Cancer.
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.
authors.affiliation: Harvard-MIT Division of Health Sciences and Technology, Harvard Medical School
authors.forename: Vinayak
authors.initials: V
authors.lastname: Muralidhar
authors.affiliation: Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Harvard Medical School
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Catalano
authors.affiliation: Center for Surgery and Public Health
authors.forename: Gally
authors.initials: G
authors.lastname: Reznor
authors.affiliation: Department of Radiation Oncology, Brigham and Women’s Hospital/Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
authors.forename: Brandon A
authors.initials: BA
authors.lastname: Mahal
authors.affiliation: Department of Medical Oncology, Brigham and Women’s Hospital/Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
authors.forename: Toni K
authors.initials: TK
authors.lastname: Choueiri
authors.affiliation: Department of Medical Oncology, Brigham and Women’s Hospital/Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Sweeney
authors.affiliation: Department of Radiation Oncology, Brigham and Women’s Hospital/Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
authors.forename: Neil E
authors.initials: NE
authors.lastname: Martin
authors.affiliation: Department of Radiation Oncology, Brigham and Women’s Hospital/Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
authors.forename: Clair J
authors.initials: CJ
authors.lastname: Beard
authors.affiliation: Department of Radiation Oncology, Brigham and Women’s Hospital/Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
authors.forename: Yu-Wei
authors.initials: YW
authors.lastname: Chen
authors.affiliation: Department of Radiation Oncology, Brigham and Women’s Hospital/Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
authors.forename: Michelle D
authors.initials: MD
authors.lastname: Nezolosky
authors.affiliation: Department of Radiation Oncology, MD Anderson Cancer Center, Houston, Texas
authors.forename: Karen E
authors.initials: KE
authors.lastname: Hoffman
authors.affiliation: Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
authors.forename: Felix Y
authors.initials: FY
authors.lastname: Feng
authors.affiliation: Department of Urology, Brigham and Women’s Hospital, Boston, Massachusetts
authors.forename: Quoc-Dien
authors.initials: QD
authors.lastname: Trinh
authors.affiliation: Department of Radiation Oncology, Brigham and Women’s Hospital/Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
authors.forename: Paul L
authors.initials: PL
authors.lastname: Nguyen
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000726:Androgen Antagonists / Q000627:therapeutic use*; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use*; D014408:Biomarkers, Tumor; D018450:Disease Progression; D006801:Humans; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D011471:Prostatic Neoplasms / Q000188:drug therapy* / Q000453:epidemiology / Q000473:pathology*; D012307:Risk Factors; D018426:SEER Program; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000726:Androgen Antagonists; D018931:Antineoplastic Agents, Hormonal; D014408:Biomarkers, Tumor