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A Bioluminescent and Fluorescent Orthotopic Syngeneic Murine Model of Androgen-dependent and Castration-resistant Prostate Cancer
Published on: March 6, 2018
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Real-World Practice Patterns and Predictors of Continuous versus Intermittent Androgen Deprivation Therapy Use for
D C Cheung1, S M H Alibhai2, L J Martin3
1Division of Urology, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
The Journal of Urology
|May 25, 2021
Summary
Intermittent androgen deprivation therapy (IADT) is underutilized in older prostate cancer patients despite evidence of non-inferiority to continuous ADT. Treatment selection involves patient, physician, and sociodemographic factors.
Area of Science:
- Oncology
- Urology
- Health Services Research
Background:
- Phase-III trials indicate intermittent androgen deprivation therapy (IADT) is not significantly inferior to continuous androgen deprivation therapy (ADT) for prostate cancer (PC).
- Clinical practice guidelines show variability in recommendations for IADT versus continuous ADT.
- Real-world utilization patterns of IADT in eligible patient populations require evaluation.
Purpose of the Study:
- To assess the real-world utilization and practice patterns of intermittent androgen deprivation therapy (IADT) in older men with prostate cancer (PC).
- To identify patient and physician predictors influencing the selection of IADT over continuous ADT.
Main Methods:
- Retrospective cohort study of Ontario men aged 65 years or older diagnosed with PC and initiating ADT (1997-2017).
- IADT classification based on defined treatment gaps (≥6 months initial, ≥3 months subsequent).
- Multivariable logistic regression analysis to determine predictors of IADT use, adjusting for disease stage and local therapy history.
Main Results:
- 16.4% of eligible patients received IADT, with utilization varying by health region and increasing in those with prior local therapy (26.6%).
- Predictors for IADT use included prior local therapy (OR 1.85) and higher income quintile (OR 1.32).
- Radiation oncologists (OR 1.99) and more experienced physicians (≥10 years, OR 1.44) were more likely to prescribe IADT; higher case volume was significant for radiation oncologists.
Conclusions:
- Intermittent androgen deprivation therapy (IADT) is underutilized in men aged 65+ with prostate cancer, with only 1 in 6 to 1 in 4 eligible patients receiving it.
- Treatment decisions for IADT are influenced by a combination of clinical factors (prior local therapy), sociodemographic characteristics (income), and physician-specific factors (specialty, experience, volume).
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