National Trends in the Utilization of Androgen Deprivation Therapy for Very Low Risk Prostate Cancer

To analyze national trends using the National Cancer Database (NCDB) in use of androgen deprivation therapy (ADT), outside of standard of care, in patients with very low risk prostate cancer.

We identified 52,797 men in the NCDB from 2010 to 2015 diagnosed with very low risk prostate cancer as defined (cT1cM0, PSA <10, Gleason ≤6, <3 biopsy cores positive). We evaluated the treatment trends and the proportion of men treated with ADT based on race, income, insurance status, treatment facility volume, and Charlson comorbidity.

From 2010 to 2015, prevalence of primary ADT use in patients with very low risk prostate cancer remained 0.7%. Patients treated at low-volume facilities were more likely to receive primary ADT (hazard ratio [HR] 1.29, P <.001) as were black patients (HR 1.47, P <.001). When evaluated over time, the proportion of men treated with primary ADT who were white decreased while the proportion of men who were black increased.

The use of primary ADT in men with very low risk prostate cancer has not changed over time, and may be over utilized, particularly among black men and those treated at low-volume facilities.