title: What do urologists think patients need to know when starting on androgen deprivation therapy? The perspective from Canada versus countries with lower gross domestic product.
abstract: BACKGROUND
  Androgen deprivation therapy (ADT) side effects are numerous and negatively impact prostate cancer patients' quality of life. There is considerable discrepancy though among Canadian urologists regarding what ADT side effects and side effect management strategies. Little is known about global differences in ADT patient education.
  
  
  METHODS
  International respondents were recruited via online posting and at an international urology conference. Hypotheses suggest that economic and cultural differences influence patient education practices; therefore, international respondents were divided into 3 categories (high, medium, and low gross domestic product).
  
  
  RESULTS
  No differences were found between responses from Canadian urologists and high GDP countries. Compared to responses from low GDP countries, Canadian urologists are more likely to endorse informing patients about: osteoporosis, loss of muscle mass, weight gain, fatigue/sleep disturbance, relationship changes, cognitive changes, and loss of body hair. Infertility was the only side effect more often disclosed by urologists in low GDP counties. Recommended management strategies for hot flashes are more likely to be pharmaceutical in Canada, and behavioral in low GDP countries. Management strategies for gynecomastia are emphasized more in low GDP countries. Physical exercise is endorsed consistently more often by Canadian urologists.
  
  
  CONCLUSIONS
  ADT educational practices vary greatly between Canada and lower GDP countries. Factors that could contribute to differences include economics (e.g., ADT drug costs), differences in side effect presentation due to different ADT drugs used, racial differences in perceived side effect burden, disease status at ADT commencement, and cultural differences in patient-physician shared-decision making.
authors.affiliation: 1 Department of Medical Neuroscience, Dalhousie University, Halifax, Nova Scotia, Canada ; 2 Department of Urologic Sciences, University of British Columbia, Vancouver, British Columbia, Canada ; 3 Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Victoria, Australia ; 4 Department of Oncology, Division of Psychosocial Oncology, Cumming School of Medicine, University of Calgary, Alberta, Canada.
authors.forename: Irena
authors.initials: I
authors.lastname: Rot
authors.affiliation: 1 Department of Medical Neuroscience, Dalhousie University, Halifax, Nova Scotia, Canada ; 2 Department of Urologic Sciences, University of British Columbia, Vancouver, British Columbia, Canada ; 3 Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Victoria, Australia ; 4 Department of Oncology, Division of Psychosocial Oncology, Cumming School of Medicine, University of Calgary, Alberta, Canada.
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Wassersug
authors.affiliation: 1 Department of Medical Neuroscience, Dalhousie University, Halifax, Nova Scotia, Canada ; 2 Department of Urologic Sciences, University of British Columbia, Vancouver, British Columbia, Canada ; 3 Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Victoria, Australia ; 4 Department of Oncology, Division of Psychosocial Oncology, Cumming School of Medicine, University of Calgary, Alberta, Canada.
authors.forename: Lauren M
authors.initials: LM
authors.lastname: Walker
keywords: Androgen deprivation therapy (ADT); hormone therapy; informed consent; patient education; prostate cancer